Use of lean methods and tools, failure mode analysis, and automation to improve the radiotherapy linear accelerator quality assurance process


Regular quality assurance (QA) checks are performed on linear accelerator treatment machines in radiotherapy to ensure they are operating safely and accurately, with the required level of precision. This enables the operator to deliver the correct amount of dose to the appropriate location in the patient. The linear accelerator QA process is complex and varies between departments in the UK. There are few publications that use lean to improve the quality of processes within healthcare, and even less describing the use of lean to improve radiotherapy processes. Despite the widespread use of lean within industry to eliminate waste and improve quality and efficiency no publications could be found in the literature describing the use of lean to improve linear accelerator QA. In addition to this, failure mode and effects analysis which can be used to minimise the risk of failures and improve reliability is recommended for QA processes by the American Association of Physics in Medicine. However, this risk based approach to QA is not commonly used and there are few studies in the literature suggesting its use for radiotherapy QA. This work describes how a lean approach was used to improve the quality of the linear accelerator QA process in one radiotherapy department. The project has brought together lean tools such as process mapping, root cause analysis, FMEA and audits to identify the problems in the QA process, implement changes and evaluate the impact of those changes. The plan-do-study-act cycle was used to implement and evaluate the changes made. In some instances several iterations of the cycle were required to reach a satisfactory solution. Automation tools were also discussed and one commercially available tool for automation of QA trends was evaluated. Lean tools and methods were used together with stakeholder engagement to successfully implement changes which have improved the linear accelerator QA process in the authors department. Some such changes include; QA scheduling, signage for determining machine status, QA documentation, training, QA priorities, communication of machine issues, equipment storage, and recording of machine calibrations.


Many changes to current practice within local department. Approx 13 changes to QA process have been made.