Use of a checklist approach on a telecobalt in an attempt to reduce human errors in radiotherapy delivery and improve therapeutic ratio

Background: The process of radiotherapy treatment planning and delivery involves multiple steps and professionals causing it to be prone to errors. Radiotherapy centers equipped with old telecobalt machines have certain peculiar challenges to workflow. We designed and tested a checklist for radiotherapy technicians (RTTs) to reduce chances of error during treatment delivery on a telecobalt machine. Materials and Methods: A physical checklist was designed for RTTs to use in the pretreatment pause using a template advocated by the American Association of Physicists in Medicine. It was tested on 4 RTTs over 1000 radiotherapy delivery sittings. Results: The checklist helped to rectify 41 documentary lapses and 28 errors in radiotherapy treatment parameters while also identifying 12 instances where treatment plan modifications were due and 30 where the patient was due for review by the radiation oncologist. The average time to go through the checklist was between 2.5 and 3 min. Conclusions: The development and use of the checklist has helped in reducing errors and also improving workflow in our department. It is recommended to utilize such physical checklists in all radiotherapy centers with telecobalt machines. The success of the checklist depends upon leadership, teamwork, acceptance of a need to inculcate a “safety culture,” with voluntary error-reporting and a willingness to learn from such errors.