magistrsko delo
Ivana Koceva (Avtor), Tanja Marinko (Recenzent), Primož Peterlin (Mentor), Valerija Žager (Komentor)

Povzetek

Uvod: Virtualna simulacija je metoda, ki jo uporabljamo za paliativno obsevanje bolnika. Pri vsakem posameznem koraku obsevanja (od priprave bolnika na simulatorju do obsevanja bolnika na linearnem pospeševalniku) se lahko zgodijo določene napake. Za zagotavljanje varnosti in kakovosti zdravljenja v radioterapiji uporabljamo tako retrospektivne kot prospektivne metode analize tveganj. Prospektivne metode analize tveganj, kot so posnetek obstoječih procesov, analiza mogočih napak in njihovih posledic (angl. Failure mode and effects analysis, FMEA) ali analiza drevesa odpovedi, so dopolnilo retrospektivnim metodam. Namen: Namen magistrskega dela je bil na primeru virtualne simulacije pri paliativnem obsevanju z uporabo prospektivnih metod analize tveganj analizirati tveganja in predlagati ukrepe za zmanjšanje tveganj v vseh korakih tega postopka. Metode dela: Anketirali smo 26 zdravstvenih delavcev in sodelavcev, udeleženih v procesu obsevanja bolnika s pomočjo virtualne simulacije. V naši raziskavi so sodelovali različni profili zdravstvenih delavcev: zdravnik – onkolog radioterapevt, medicinski fizik/dozimetrist ter radiološki inženir na radioterapevtskem računalniško tomografskem (CT) simulatorju in na linearnem pospeševalniku. Anketna vprašanja so predstavljala napake, do katerih lahko pride v procesu priprave in obsevanja bolnika v obliki virtualne simulacije. Vsaki napaki oz. odvisni spremenljivki smo pripisali vrednost od 1 do 10. Zdravstveni delavci so ocenjevali pogostost napake, resnost in verjetnost odkritja napake pred obsevanjem bolnika. Na podlagi rezultatov smo izračunali mediano prednostnega števila tveganja (RPN), ki je produkt resnosti napake (S), pogostosti napake (O) in verjetnosti, da napaka ne bo pravočasno odkrita (D). Rezultati: Radiološki inženirji, ki delajo na radioterapevtskem CT-simulatorju, so kot najbolj nevarni napaki izbrali »Zamenjava bolnika, in to kljub preverjanju identitete« in »Razvrščanje napačnega bolnika«, kjer je mediana resnosti napake 10 in mediana produktov RPN 60. Napaka »Določimo premajhno oz. preveliko obsevalno polje« je po mnenju zdravnikov –onkologov radioterapevtov zelo nevarna napaka, saj znaša mediana produktov RPN = 245. Po mnenju medicinskih fizikov ima napaka »Uvozimo set CT-slik za napačnega bolnika« najvišjo mediano produktov; RPN = 100,5. Radiološki inženirji, ki delajo na linearnem pospeševalniku, so ocenili kot najbolj nevarno napako »Ob preverjanju podatkov spregledamo neskladnost v parametrih obsevanja med obsevalnim kartonom in sistemom ARIA« (RPN = 72). Razprava in zaključek: Skupina zdravnikov –onkologov radioterapevtov je bila najbolj kritična pri ocenjevanju napak. Ocene produktov RPN so pri njih precej višje kot pri ostalih skupinah anketirancev, kar ne pomeni, da so ostale napake zanemarljive. Raziskava je lahko izhodišče za analizo napak, ki se pojavijo pri drugih obsevalnih tehnikah.

Ključne besede

magistrska dela;radiološka tehnologija;FMEA;kakovost v radioterapiji;prospektivna metoda;virtualna simulacija;

Podatki

Jezik: Slovenski jezik
Leto izida:
Tipologija: 2.09 - Magistrsko delo
Organizacija: UL ZF - Zdravstvena fakulteta
Založnik: [I. Koceva]
UDK: 616-07
COBISS: 64624387 Povezava se bo odprla v novem oknu
Št. ogledov: 404
Št. prenosov: 65
Ocena: 0 (0 glasov)
Metapodatki: JSON JSON-RDF JSON-LD TURTLE N-TRIPLES XML RDFA MICRODATA DC-XML DC-RDF RDF

Ostali podatki

Sekundarni jezik: Angleški jezik
Sekundarni naslov: Using prospective risk analysis methods for quality assurance in radiotherapy
Sekundarni povzetek: Introduction: Virtual simulation is a method used for palliative radiation of a patient. Errors can occur at each individual step of irradiation, starting from preparing the patient on the simulator and up to patient irradiation on a linear accelerator. To ensure safety and quality treatment in radiotherapy both retrospective as well as prospective risk analysis methods are used. Prospective risk analysis methods like Process mapping, Failure mode and effects analysis (FMEA), Failure tree analysis complement the retrospective methods of risk analysis. Purpose: The purpose of this master’s thesis is using virtual simulation in palliative treatment as a case in which prospective methods of risk analysis are employed to analyze the risks and suggest the action to be taken to reduce the risks in all steps of this process. Methods: We surveyed 26 healthcare professionals involved in the process of patient irradiation using virtual simulation. Our research included healthcare professionals from different fields such as: doctor – radiation oncologist, medical physicist/dosimetrist, radiation therapist working on a radiotherapy computed tomography (CT) simulator and on a linear accelerator. Survey questions represented failure modes which could occur in the process of preparation and during irradiation of the patient using virtual simulation. Every failure mode was assigned a value from 1 to 10. Healthcare professionals graded the frequency of the failure mode occurrence (O), its severity (S) and likelihood of discovering the mistake before irradiating the patient (D). Afterwards we calculated the median of the risk priority numbers (RPN), calculated as the product of failure mode occurrence, severity and detectability. Results: Radiotherapists working on a radiotherapy CT simulator chose »Incorrect patient, despite identity verification« and »Faulty patient classification« as the most dangerous mistakes, with the maximal median severity of the error (S) 10 and the median RPN value equal to 60. Radiation oncologists chose »Determining too big or too small of a radiation field« as the most dangerous error, with the median RPN value of 245. Error ”Importing a CT set for the wrong patient” has the highest median RPN value of 100.5, as graded by medical physicists. Radiotherapists working on the linear accelerator graded »When checking data, discrepancy in the radiation parameters between the treatment chart and ARIA system are overlooked« as the most dangerous error (RPN = 72). Discussion and conclusion: The group of radiation oncologists were the most critical in their assessment of errors. RPN values in this group are much higher than in other groups of respondents, which does not mean that other errors that occur in the process of patient treatment with palliative care are negligible. This research can be the starting point for the analysis of errors that occur in other methods of irradiation.
Sekundarne ključne besede: master's theses;radiologic technology;FMEA;quality assurance in radiotherapy;prospective methods;virtual simulation;
Vrsta dela (COBISS): Magistrsko delo/naloga
Študijski program: 0
Komentar na gradivo: Univ. v Ljubljani, Zdravstvena fak., Oddelek za radiološko tehnologijo
Strani: 70 str.
ID: 12943123