S2365
Physics - Quality assurance and auditing
ESTRO 2026
brachytherapy (PIPB), combining HFMEA (Healthcare Failure Modes and Effects Analysis) and FRAM (Functional Resonance Analysis Method) to evaluate patient and staff safety in the Iodine-125 seed implantation procedure. Material/Methods: The study was conducted in the Brachytherapy Service of a Portuguese Public Institute, using documentary analysis, on-site observation, and focus group sessions involving radiation oncologists, medical physicists, radiation therapists, and nurses. The assessment was performed in two sequential steps: first, HFMEA was applied to identify potential failure modes and prioritize critical risks; subsequently, FRAM was implemented to analyse functional variability and interactions within the procedure. Results: The HFMEA method identified 37 failure modes: 29 related to patient safety and 8 to occupational safety. The failure modes were ranked using a Risk Priority Number (RPN) index, derived from the probability of occurrence of a specific failure (O), the severity of its associated consequences (S), and the likelihood of detection before occurrence (D). The most critical failure modes (Table 1) included incorrect delineation of the target volume (PTV) and organs at risk (OAR), seed implantation in the wrong location, absence of post-implant dosimetry for patient safety and seed loss due to improper handling/malfunction of the Mick applicator and manual cutting of stranded seeds for occupational safety. The main causes involved organizational factors (interruptions, time pressure), human factors (inexperience, distraction), communication factors, and systemic factors (lack of
Figure 2: The mean GTV and PTV doses for the two centres The line indicates ±1sd. Conclusion: Automated extraction and analysis were achieved for 18 of 24 desired metrics. Limitations in data extraction were found in multi-vendor systems. Despite this, the audit highlighted areas of non-compliance at one or both centres and demonstrated potential for scalable, automated quality auditing adaptable to evolving evidence and technology. References: 1. Field M, et al. Implementation of the Australian Computer-Assisted Theragnostics (AusCAT) network for radiation oncology data extraction, reporting and distributed learning. J Med Imaging Radiat Oncol. 2021;65(5)2. Chlap P, et al. PyDicer: An open- source python library for conversion and analysis of radiotherapy DICOM data. SoftwareX. 2025;29:1020103. EviQ. Spinal bone metastases palliative EBRT stereotactic, NSW, Australia: Cancer Institute NSW; 2022 eviq.org.au/radiation- oncology/palliative/4098-spinal-bone-metastases- palliative-ebrt-stereo.4. Cox BW, et al. International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2012;83(5) Keywords: Automated auditing, Spine SABR Integration of FRAM and HFMEA Methodologies in Risk Assessment: A Case Study on Patient and Professional Radiological Safety in Prostate Brachytherapy Marina Maçães 1 , Catarina Souto 1,2 , Joana Fernandes 3,4 , Filipe Dias 1,2 , Alexandre Pereira 1,2 , Inês Lima 1 , Diana Correia 5 , Lurdes Trigo 5 , Matilde Rodrigues 4,6 1 Medical Physics Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal. 2 Medical Physics Radiobiology and Radiation Protection Group, IPO Porto Research Center CI-IPOP, Porto Comprehensive Cancer Center (Porto.CCC) & Rise@CI- IPOP (Health Research Network), Porto, Portugal. 3 ALGORITMI Research Center, Industrial Engineering and Management, UMinho, Guimarães, Portugal. 4 E2S, Polytechnic Institute of Porto, Porto, Portugal. Digital Poster 2715 5 Brachytherapy Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal. 6 RISE-Health, Center for Translational Health and Medical Biotechnology Research (TBIO), ES2, Polytechnic Institute of Porto, Porto, Portugal Purpose/Objective: This work presents an integrated radiological risk assessment in permanent interstitial prostate
adequate training).
FRAM complemented this analysis by mapping 35 interdependent functions (Figure 1), revealing how normal variabilities in daily work can amplify through critical couplings and generate functional resonances.
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