{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T14:01:53Z","timestamp":1789740113305,"version":"4.0.1"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>External beam radiation therapy (RT) involves many complex steps to safely and reliably treat patients. The radiation oncology community has adopted process maps and failure modes and effects analysis (FMEA) to analyze risk using the TG\u2011100 methodology, but the traditional TG\u2011100\u2013endorsed risk priority number (RPN) has recognized limitations. An updated risk\u2011profile introduced by the automotive industry, action priority (AP), offers a severity\u2011weighted alternative that may better support risk\u2011based decision\u2011making in RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the traditional RPN\u2010based FMEA approach with the updated AP\u2010based approach for identifying high\u2010risk potential failure modes (PFMs) in a representative external beam RT workflow across multiple institutions, and to assess whether the AP framework provides additional value to the radiation oncology community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine physicists from different cancer centers in Ontario, Canada collaboratively developed and refined a list of 63 PFMs associated with a generic RT workflow requiring data transfer. Each PFM was scored for occurrence (O), severity (S), and detectability (D) using TG\u2011100 recommendations. Three scoring scenarios were evaluated: average, worst\u2011case, and a severity\u2011focused score. High\u2011risk PFMs were identified using the traditional (top RPN quartile and\/or S \u2265 8) and the updated (High or Medium AP categories) FMEA criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven high\u2011risk PFMs were selected using the updated FMEA, and an additional 23 were selected using the traditional FMEA. All PFMs identified by the updated FMEA approach were also selected by the traditional FMEA approach; however, the traditional FMEA approach identified many additional PFMs due to its quartile\u2011based and severity\u2010threshold criteria. The updated AP approach appeared less affected by the scoring variability which may reduce the need for consensus discussion, it was generally easier to apply, showed more consistent behaviour across FMEA iterations and provided a clearer action guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of the updated AP approach in this study suggests a clearer, severity\u2010driven, and more streamlined strategy to prioritize high\u2010risk PFMs, potentially reducing the burden of multi\u2011institutional FMEA while maintaining consistent identification of critical risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70674","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:04:19Z","timestamp":1786680259000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Application of an updated severity\u2010based FMEA approach to Radiation Therapy QA: A multi\u2010institutional exercise"],"prefix":"10.1002","volume":"27","author":[{"given":"Alejandra","family":"Rangel","sequence":"first","affiliation":[{"name":"Medical Physics Department Trillium Health Partners \u2010 Credit Valley Hospital  Mississauga Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Studinski","sequence":"additional","affiliation":[{"name":"Department of Physics Juravinski Hospital and Cancer Centre at Hamilton Health Sciences  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ady","family":"Abdellatif","sequence":"additional","affiliation":[{"name":"Medical Physics Department R. 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McLaughlin Durham Regional Cancer Centre Lakeridge Health  Oshawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Conroy","sequence":"additional","affiliation":[{"name":"Radiation Medicine Program Princess Margaret Cancer Centre  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"King","sequence":"additional","affiliation":[{"name":"Medical Physics Department, Hudson Regional Cancer Program (North Simcoe Muskoka) Royal Victoria Regional Health Centre  Barrie Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0562-0127","authenticated-orcid":false,"given":"Humza","family":"Nusrat","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Henry Ford Health  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Oliver","sequence":"additional","affiliation":[{"name":"Medical Physics Department, Shirley and Jim Fielding Northeast Cancer Center Health Sciences North  Sudbury Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"AspL BankM FieldsT et\u00a0al et\u00a0al.AAPM Task Group Report 038: The role of a physicist in radiation oncology. 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Paper presented at:Annual Reliability and Maintainability Symposium 2003;Tampa USA."},{"key":"e_1_2_9_16_1","unstructured":"Automotive Industry Action Group. Available at:https:\/\/www.aiag.org"},{"key":"e_1_2_9_17_1","unstructured":"Verband der Automobilindustrie. Available at:https:\/\/www.vda.de\/en"},{"key":"e_1_2_9_18_1","volume-title":"Automotive Industry Action Group, Verband der Automobilindustrie. AIAG & VDA FMEA Handbook","year":"2019"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/app152413199"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.62704\/10057\/24747"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/08982112.2023.2193895"},{"key":"e_1_2_9_22_1","unstructured":"RamlyEF AtanH FMEA AIAG\u2010VDA\u2014Commentary and Case Study. 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