Download Definition of Medical Event in Permanent Implant Brachytherapy April 24, 2012

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Transcript
Definition of Medical
Event in Permanent
Implant Brachytherapy
April 24, 2012
Dr. Anthony Zietman
On behalf of the American
Society for Radiation Oncology
(ASTRO)
Current Definition
• It is deemed to be a medical
event if “the total dose delivered
differs from the prescribed dose
by 20% or more.”
• This definition relies on
estimates of absorbed dose
which is hard to quantify.
Problems with Definition
• Permanent implant prostate
brachytherapy is a dynamic
procedure impacted by:
• Changes in size and shape of
prostate
• Imaging modalities used -Ultrasound and CT
ASTRO Recommendation
• Target-based definition
• It is deemed to be a medical
event if more than 20% of
source strength is implanted
outside the planning target
volume
Rationale
• The total source strength
implanted within and around the
prostate is under control of the
authorized user.
• The subsequent prostate volume
and the resultant dose to the
prostate is not.
Conclusion
• It is important to capture those
events that could cause serious
patient harm.
• Target-based definition would
identify true errors and weed out
medically acceptable implants.