{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T12:05:59Z","timestamp":1773317159478,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T00:00:00Z","timestamp":1663113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is growing interest among pediatric institutions for implementing iodine\u2010131 (I\u2010131) meta\u2010iodobenzylguanidine (MIBG) therapy for treating children with high\u2010risk neuroblastoma. Due to regulations on the medical use of radioactive material (RAM), and the complexity and safety risks associated with the procedure, a multidisciplinary team involving radiation therapy\/safety experts is required. Here, we describe methods for implementing pediatric I\u2010131 MIBG therapy and evaluate our program's robustness via failure modes and effects analysis (FMEA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We formed a multidisciplinary team, involving pediatric oncology, radiation oncology, and radiation safety staff. To evaluate the robustness of the therapy workflow and quantitatively assess potential safety risks, an FMEA was performed. Failure modes were scored (1\u201310) for their risk of occurrence (<jats:italic>O<\/jats:italic>), severity (<jats:italic>S<\/jats:italic>), and being undetected (<jats:italic>D<\/jats:italic>). Risk priority number (RPN) was calculated from a product of these scores and used to identify high\u2010risk failure modes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 176 failure modes were identified and scored. The majority (94%) of failure modes scored low (RPN &lt;100). The highest risk failure modes were related to training and to drug\u2010infusion procedures, with the highest <jats:italic>S<\/jats:italic> scores being (a) caregivers did not understand radiation safety training (<jats:italic>O<\/jats:italic>\u00a0=\u00a05.5, <jats:italic>S<\/jats:italic>\u00a0=\u00a07, <jats:italic>D<\/jats:italic>\u00a0=\u00a05.5, RPN\u00a0=\u00a0212); (b) infusion training of staff was inadequate (<jats:italic>O<\/jats:italic>\u00a0=\u00a05, <jats:italic>S<\/jats:italic>\u00a0=\u00a08, <jats:italic>D<\/jats:italic>\u00a0=\u00a05, RPN\u00a0=\u00a0200); and (c) air in intravenous lines\/not monitoring for air in lines (<jats:italic>O<\/jats:italic>\u00a0=\u00a04.5, <jats:italic>S<\/jats:italic>\u00a0=\u00a08, <jats:italic>D<\/jats:italic>\u00a0=\u00a05, RPN\u00a0=\u00a0180).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Through use of FMEA methodology, we successfully identified multiple potential points of failure that have allowed us to proactively mitigate risks when implementing a pediatric MIBG program.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29996","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T13:35:59Z","timestamp":1663162559000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Failure modes and effects analysis of pediatric I\u2010131 MIBG therapy: Program design and potential pitfalls"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7230-9793","authenticated-orcid":false,"given":"Nichole M.","family":"Maughan","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose L.","family":"Garcia\u2010Ramirez","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick S","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel N.","family":"Willis","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Department of Pediatrics Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amir","family":"Iravani","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine Department of Radiology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxwell","family":"Amurao","sequence":"additional","affiliation":[{"name":"Division of Radiation Safety Department of Environmental Health and Safety Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Luechtefeld","sequence":"additional","affiliation":[{"name":"Division of Radiation Safety Department of Environmental Health and Safety Washington University in St. Louis  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6136-265X","authenticated-orcid":false,"given":"Joyce C.","family":"Mhlanga","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine Department of Radiology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie M.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline E.","family":"Zoberi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,9,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.4648"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2013.11.016"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semnuclmed.2011.05.003"},{"key":"e_1_2_9_5_1","volume-title":"The Cleveland Clinic Guide to Thyroid Disorders (Cleveland Clinic Guides)","author":"Skugor 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