ABSTRACT
Historically, for radiation oncology, one of the largest sources of errors has been the transfer of information regarding technical parameters to treat patients (Valli et al. 1994). Although streamlining of data transfer has increased dramatically over time, scenarios still exist for incorrect information to move from treatment planning to the treatment machine via conduits such as electronic medical record systems, record and verify systems, or other direct transfer methods. ere have been numerous reports (Goldwein, Podmaniczky, and Macklis 2003; Klein et al. 2005; Macklis, Meier, and Weinhous 1998; Patton, Ganey, and Moeller 2003) that analyze, retrospectively and prospectively, error occurrence. Although the methods for data transfer have improved by removing human intervention, there have been instances where users have taken for granted quality assurance reviews, which are still needed. As localization imaging within the treatment room is now becoming more of a standard method for image-guided radiation therapy, another source of potential error has arisen. If we map the evolution of data transfer through the end of the twentieth century, hard copy, paper, and lm were the methods of data transfer. Coincidentally, the complexity of treatments in terms of number of elds and variations were fairly limited in 1999, compared to 2009. e advent of intensity modulated radiation therapy (IMRT) to many nonacademic facilities also occurred at the end of the twentieth century. ere were many manual methods during this time period that customized treatment elds for radiotherapy such as: eld-shaping apertures such as cerrobend blocks; compensation devices such as wedges and custom-made metal compensators; use of bolus, etc.; and the use of nonaxial elds requiring table rotations. Some of the errors most damaging to patients were related to wedge positioning and orientations.
