Page 54 - ARNM-1-1

Advances in Radiotherapy
& Nuclear Medicine Barcode system for immobilization device

introduced. The number of reports concerning patient an instructed dose, which was solved by adding a logic
positioning 5 years before the barcode certification system system to our RIS to remove the barcode authorization
was introduced was 12. Misplacing of the bolus was reported when the accumulated dose reached the instructed dose.
several times; however, the number of cases decreased to 4, The third IA is concerning with falling off of a bolus during
in the 5 years when the barcode certification system was irradiation. This cannot be prevented by our barcode
introduced (Table 2). There was a significant difference system. Thus, the solution is to fix the bolus firmly and to
(P = 0.03663: Two-sample test for equality of proportions observe the patient throughout the irradiation with the use
without continuity correction) between before and after of a monitoring camera.
the introduction of the barcode certification system We also investigated the time efficiency of barcode
(Figure 5). The specifics of the IA reports concerning certification system. The treatment time (average ± standard
patient positioning are shown in Table 3. An IA concerning deviation) per patient was 7.87 ± 1.83 min and
patient setup, immobilization device error, and misplacing 7.77 ± 1.66 min, before and after the barcode certification
of bolus have not been reported since the introduction was introduced, respectively. The sampling data were
of the barcode certification system. However, the four 137 and 119, respectively, and the Student’s t-test showed
IAs were reported after the barcode certification system risk factor 0.6657 (P > 0.05), which indicates there is no
was introduced. The first IA is concerning a wrong table significant difference between treatment times.
couch, which had not been included in preceding object as
a barcode certification. After this IA, the table couch was 4. Discussion
included as a preceding object for the barcode verification After verifying and analyzing the past IA reports, we
and such IA became preventable thereafter. The second found that misplacing the bolus was the most frequent IA
and fourth Ias are concerning with bolus not removed at concerning patient positioning. Using a barcode system,

Table 2. Comparison of before and after barcode system was introduced

Introduction of barcode system
Before After
Number of patients treated with external RT 8564 8951
Number of IA reports in RT 160 111
Number of IA reports concerning patient setup 12 4
Ratio of IA reports to patient treated with external RT (%) 0.1341 0.0467
P-value 0.03663
Abbreviations: IA: Incidents/accidents; RT: Radiation therapy.

Table 3. Specifics of the IA reports concerning patient positioning
IA Reports
Before the barcode system was introduced After the barcode system was introduced
1 Bolus was not put on the patient when it should be Table top of the couch was incorrect
2 Bolus was not put on the patient when it should be Bolus was not removed at instructed dose
3 Incorrect pillow for head shell was used Bolus fell off during RT but radiologist did not notice
4 Couch rail was not closed when it should be Bolus was not removed at instructed dose
5 Couch rail was not closed when it should be
6 Feet rest was not used when it should
7 Incorrect pillow for headshell was used
8 Bolus was not put on the patient when it should be
9 Bolus was put on incorrect place
10 Bolus was not put on the patient when it should be
11 Incorrect immobilization device was used
12 Couch rail was not open when it should be
Abbreviations: IA: Incidents/accidents; RT: Radiation therapy.

Volume 1 Issue 1 (2023) 5 https://doi.org/10.36922/arnm.1036