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Advances in Radiotherapy
& Nuclear Medicine Barcode system for immobilization device

listed. Barcode must be scanned one by one, and when the 2.4. Analysis
wrong immobilization device is set and a wrong barcode The statistical analysis was performed using R, a free
is scanned, an error message would be displayed on the statistical program (R ver. 3.3.3 Development Core
RIS monitor. The RIS setup information is shown on the Team [8,9] ). The statistical significance was evaluated by
monitors, in the LINAC and the control rooms (Figure 4). comparing the numbers of IA reports before and after the
Radiation therapy could not be performed until the RIS
barcode certification system is certified. barcode system was introduced using two-sample test for
equality of proportions without continuity correction.
2.3. Data collection
2.5. Time efficiency
This study was approved by the institutional review
board of our institution (IRB no. 2015 – 1025). We have We investigated the length of treatment time per patient,
conducted a before-and-after study by searching IA reports based on the RIS log file, from the time of entering LINAC
submitted in our radiation oncology department in the last room to when irradiation had been performed, before
10 years; then, we identified the reports on the misuse of and after the barcode certification system was introduced.
immobilization devices and the registration errors. The The evaluation was limited to 4-field radiation therapy for
radiation technologists who worked during this period breast cancer patients without collation photography. The
were not the same group of people, and we were unable reason is that it is one of the few treatment areas that has not
to discern the differences in the years of experience of the changed much over the past few years and a large number
radiation technologists based on the IA report. Our barcode of patients have been treated by this method. The data were
certification system was introduced in 2015, and the data accumulated from December 2014 (137 cases; before the
spanning for 10 years from January 1, 2010, to December barcode was introduced) to December 2019 (119 cases;
31, 2019, were collected. We observed how the number of after the barcode was introduced). The data were analyzed
IA reports on these errors changed after the introduction with Student’s t-test.
of the barcode system. IA report regarding immobilization
and patient setup were selected and tabulated by each item 3. Results
before and after the introduction of the barcode system. The number of patients treated with external radiation
The IA reports were classified using the original therapy at our institution 5 years before (2010−2014)
classification of our institution made by medical safety and after the barcode certification system was introduced
management department. The reports were classified into (2015−2019) was 8,951 and 8,564, respectively. The total
five levels from Level 0 defined as IA causing no harm number of IA reports submitted to the Medical Safety
to the patient, to Level 5 defined as IA causing patient Department from the Radiation Oncology Department
death. The level increased as the influence of the accident during that period was 271, with 160 reported before and
increased. 111 reported after the barcode certification system was

A B

Figure 4. Radiation information system setup information shown on display. (A) Monitor in the control room; (B) Monitor in the linear accelerator room.
The color changes from yellow to white after performing barcode authentication. The warning pop displays when the wrong immobilization device is used,
and the color remains yellow if the device is not placed or authentication is not performed.

Volume 1 Issue 1 (2023) 4 https://doi.org/10.36922/arnm.1036