{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T08:28:44Z","timestamp":1760171324473,"version":"3.41.2"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To identify high\u2010priority risks in a clinical trial investigating the use of radiation to alleviate COVID\u201019 pneumonia using a multi\u2010phase failure modes and effects analysis (FMEA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive FMEA survey of 133 possible causes of failure was developed for the clinical trial workflow (Phase I). The occurrence, severity, and detection risk of each possible cause of failure was scored by three medical physicists. High\u2010risk potential failure modes were identified using the risk priority number (RPN) and severity scores, which were re\u2010scored by 13 participants in radiation oncology (Phase II). Phase II survey scores were evaluated to identify steps requiring possible intervention and examine risk perception patterns. The Phase II participants provided consensus scores as a group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty high\u2010priority failure modes were selected for the Phase II survey. Strong internal consistency was shown in both surveys using Cronbach's alpha (<jats:italic>\u03b1<\/jats:italic><jats:sub>c<\/jats:sub>\u00a0\u2265\u00a00.85). The 10 failures with the largest median RPN values concerned SARS\u2010CoV\u20102 transmission (<jats:italic>N<\/jats:italic>\u00a0=\u00a06), wrong treatment (<jats:italic>N<\/jats:italic>\u00a0=\u00a03), and patient injury (<jats:italic>N<\/jats:italic>\u00a0=\u00a01). The median RPN was larger for COVID\u2010related failures than other failure types, primarily due to the perceived difficulty of failure detection. Group re\u2010scoring retained 8\/10 of the highest\u2010priority risk steps that were identified in the Phase II process, and discussion revealed interpretation differences of process steps and risk evaluation. Participants who were directly involved with the trial working group had stronger agreement on severity scores than those who were not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The high ranking of failures concerning SARS\u2010CoV\u20102 transmission suggest that these steps may require additional quality management intervention when treating critically ill COVID\u201019+ patients. The results also suggest that a multi\u2010phase FMEA survey led by a facilitator may be a useful tool for assessing risks in radiation oncology procedures, supporting future efforts to adapt FMEA to clinical procedures.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14261","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T19:59:42Z","timestamp":1704830382000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multi\u2010phase failure modes and effects analysis for low dose bilateral whole lung irradiation of COVID\u201019 positive patients requiring respiratory ventilation"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9209-242X","authenticated-orcid":false,"given":"Amanda E.","family":"Swanson","sequence":"first","affiliation":[{"name":"Department of Radiation Medicine Oregon Health &amp; Science University  Portland Oregon USA"},{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3222-7141","authenticated-orcid":false,"given":"Dominic J.","family":"DiCostanzo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilendu","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Hintenlang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arnab","family":"Chakravarti","sequence":"additional","affiliation":[{"name":"Department of 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