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Advances in Radiotherapy
& Nuclear Medicine Barcode system for immobilization device

radiotherapy is not feasible before a barcode certification
system is introduced, but the setup-related errors could
be reduced, which is the most important objective of their
study. Scott-Brown et al. have reported that the quality
[10]
of life of patients has improved in many ways when treated
with intensity-modulated radiotherapy compared with
conformal radiotherapy, and multiple immobilization
devices are carefully chosen to meet the irradiation
goal. Suzuki et al. reported that in high-precision
[11]
radiotherapy, it is important to reduce the variation in
irradiation position caused by patient immobilization. The
proper use of immobilization device is important to ensure
accurate dose distribution. Barcode certification system
is a simple and not time-consuming technique that can
prevent errors.
Figure 5. Comparison of the number of IA reports before and after the
barcode system was introduced. The number of IA reports decreased from Studies concerning safety in medicine have been
12 to 4 after the barcode system was introduced. There was a significant reported in the past. Failure Mode and Effects Analysis
difference (P < 0.05 by R test). (FMEA) is one of the techniques to evaluate the error and
risk factor and has widely been used in factories and in
we could reduce the number of IA reports from 12 to 4. industrial systems, and has been used in medical safety
Misplacing of the bolus has not occurred since the barcode evaluation in recent years [12,13] . FMEA is used to analyze
introduced, but there were still four incidences concerning the risk factor by multiplying occurrence (O), severity (S),
bolus after the barcode system was introduced. There was a and detection (D). Introducing a barcode system in patient
time when the bolus had to be taken off at the instructed dose setup will minimize the detection (D) because it will
but forgotten. To prevent this situation, we have upgraded remove human error; therefore, risk factor can be reduced
our RIS to automatically remove bolus barcode certification significantly. Although there have been reports on
when it reaches the instructed dose with bolus. This will analyzing the safety in medicine, this study is, to the best
alert the radiotherapist to not place the bolus. However still, of our knowledge, the first report to show the effectiveness
several limitations in this study caught our attention, such of a barcode system in preventing incorrect use of patient
as falling off of the bolus during treatment, which is difficult immobilization devices in radiation therapy.
to prevent. Other possible limitations include the difficulty
using barcode on immobilization devices. For example, 5. Conclusion
Posi-rest (immobilization device for the upper body) can
be adjusted to three different angles, and oriented to the left With the improvement in radiation therapy techniques,
and right, separately, but it is difficult to place the barcode complicated setups for individual patients are necessary,
for individual patient’s position. Furthermore, sliding which increase the risk of improper usage of immobilization
locating bar is used to fix immobilization device on the devices. Therefore, an authentication system of patient’s
treatment couch. Sliding bar can be moved in millimeter, individual therapeutic devices using barcode is necessary
making it difficult to manage barcodes. to avoid the improper use of immobilization devices and
misplacement of the bolus, thus regaining the proper
A recent study in the Princess Margaret Hospital, couch shape for high-precision treatment. The IA reports
Canada, has analyzed 1063 incident reports in 7 years show that the barcode certification system is an efficient
(2001 – 2007) and reported that the most frequent error tool to reduce errors concerning patient setup in radiation
occurred was the process of treatment planning and therapy.
irradiation , and the second most common incident
[4]
was the accessory-related error, which includes errors in Acknowledgments
immobilization device. They also sorted the incidents by
generic cause, weighted by severity score, which showed We acknowledge the Radiation Oncology Department,
that accessory-related errors were significant. Given the The Cancer Institute Hospital of the Japanese Foundation
magnitude of the error when it actually occurred, the for Cancer Research for all the support.
utility of preventing this error in advance through barcode Funding
certification system is significant. Thus, it is apparent that
based on their findings, the reduction of overall IAs in None.

Volume 1 Issue 1 (2023) 6 https://doi.org/10.36922/arnm.1036