T. Pawlicki

University of California, San Diego, San Diego, California, United States

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Publications (89)167 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Incident learning plays a key role in improving quality and safety in a wide range of industries and medical disciplines. However, implementing an effective incident learning system is complex, especially in radiation oncology. One current barrier is the lack of technical standards to guide users or developers. This report, the product of an initiative by the Work Group on Prevention of Errors in Radiation Oncology of the American Association of Physicists in Medicine, provides technical recommendations for the content and structure of incident learning databases in radiation oncology.Methods: A panel of experts was assembled and tasked with developing consensus recommendations in five key areas: definitions, process maps, severity scales, causality taxonomy, and data elements. Experts included representatives from all major North American radiation oncology organizations as well as users and developers of public and in-house reporting systems with over two decades of collective experience. Recommendations were developed that take into account existing incident learning systems as well as the requirements of outside agencies.Results: Consensus recommendations are provided for the five major topic areas. In the process mapping task, 91 common steps were identified for external beam radiation therapy and 88 in brachytherapy. A novel feature of the process maps is the identification of "safety barriers," also known as critical control points, which are any process steps whose primary function is to prevent errors or mistakes from occurring or propagating through the radiotherapy workflow. Other recommendations include a ten-level medical severity scale designed to reflect the observed or estimated harm to a patient, a radiation oncology-specific root causes table to facilitate and regularize root-cause analyses, and recommendations for data elements and structures to aid in development of electronic databases. Also presented is a list of key functional requirements of any reporting system.Conclusions: Incident learning is recognized as an invaluable tool for improving the quality and safety of treatments. The consensus recommendations in this report are intended to facilitate the implementation of such systems within individual clinics as well as on broader national and international scales.
    Medical Physics 12/2012; 39(12):7272-90. · 2.91 Impact Factor
  • T Pawlicki, M Huq, S Mutic, D Low
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    ABSTRACT: Attendees are taught an efficient organizational framework for Part II exam preparation that maximizes high-yield active learning study activities and minimizes low-yield study activities. This method is then combined with a productive group-based study technique. The format and scope of the Part II ABR exam in radiotherapy physics is described, and the eligibility requirements are reviewed. High-yield and low-yield study activities are defined and examples are discussed in detail. A problem-based strategy for limiting the scope of study material is described. A method for studying in groups by distributing delegable tasks among multiple group members and ensuring their completion is described.Learning Objectives1. Understand the scope of material covered on Part II of the ABR radiotherapy physics exam and which references to study for the exam.2. Be able to design and execute an efficient study plan that enables an active learning approach.3. Learn to use group study techniques to enhance efficiency.
    Medical Physics 06/2012; 39(6):3929. · 2.91 Impact Factor
  • T Harry, M Whitaker, T Pawlicki
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    ABSTRACT: Purpose: Mathematical models are used in Industrial & Systems Engineering to analyze complex integrated operational systems. Adapting this approach to radiation therapy can help quantify the precision and accuracy necessary to achieve optimal outcome of radiation treatment. The purpose of this work is to develop such a model using clinical data and assess the effect uncertainties have on treatment outcomes. Methods: The Taguchi Loss Function (TLF) is adapted to radiation therapy using conventional radiobiological models for tumor control probabilities (TCP) and normal tissues complication probabilities (NTCP) based on the equivalent uniform dose. The TCP and NTCP curves are combined to create a failure probability function for a given treatment plan. The composite effects of all uncertainties involved in treating a patient are modeled by a normal distribution. The standard deviation and mean of the normal distribution represent the precision and accuracy of a treatment. The failure probability function is convolved with the normal distribution to arrive at an expected failure probability. Precision was varied from 0.5% to 25% while accuracy ranged from ±5% to investigate uncertainties effects on complication-free local tumor control. 3D 4-field box plans where compared to IMRT plans for 18 prostate patients using this method. Results: The average expected failure probability at the prescription dose for the 3D 4-field box plans was 30.02% and 18.13% for the IMRT plans at zero uncertainty. At 25% uncertainty the expected failure probabilities were 76.85% and 64.36%, respectively. On average the IMRT plans failure probability was 14.84% less than the 3D 4-field box plans for all uncertainty levels. Conclusion: This study demonstrates that uncertainty in radiotherapy procedures has a quantifiable effect on treatment outcome. To further improve complication-free local tumor control we must both improve treatment technologies and improve quality to minimize the uncertainties in radiation therapy.
    Medical Physics 06/2012; 39(6):3760-3761. · 2.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To evaluate the clinical implementation of a deep inspiration breath hold (DIBH) treatment for left breast radiotherapy using surface imaging and visual aid. Methods: A CT scan of the patient at DIBH is acquired and used for treatment planning. The plan and skin contour, containing isocenter and surface information are exported from the treatment planning system and imported into the surface imaging system (SIS). The skin contour constitutes the treatment reference surface or target DIBH position. A region of interest (ROI) consisting of the sternum and medial breasts is selected in the SIS. A set of video goggles allows the patient to view their breathing signal within the SIS, aiding in producing a reproducible and stable DIBH similar to simulation. Once the patient is set up at free breathing, she performs a DIBH while being monitored with the SIS. Shifts to minimize displacements from their reference DIBH surface are made. The surface image and patient setup are validated with weekly MV images. The beam is enabled when the two surfaces are within a predetermined tolerance. Results: Data for evaluation of the implementation was acquired for 4 patients throughout treatment. Average treatment time was 16.8 minutes and 14.2 minutes for setup. The average displacement from the reference surface was 0.4 mm during DIBHs. The average reduction of heart mean dose and volume receiving 50% of the prescribed dose between DIBH and FB was 38% and 89% respectively. A total of 15 patients have completed this new treatment. 2 were excluded for inability to achieve reproducible and stable DIBH.Conclusion: The workflow we have implemented has proven to be effective and efficient for clinical purposes. Surface imaging provides adequate real time information valuable to the treatment process. Visual aid has helped patients achieve DIBH with high reproducibility and stability.
    Medical Physics 06/2012; 39(6):3972. · 2.91 Impact Factor
  • G Kim, D Cao, T Pawlicki
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    ABSTRACT: Intensity modulated radiotherapy (IMRT) has been used clinically for many years. Reports from the RPC indicate that up to 30% of the institutions fail to pass RPC IMRT credentialing process on the first attempt. While volumetric modulated arc therapy (VMAT) has been introduced more recently, it has quickly gained wide clinical use. In spite of the long history with IMRT and rapid adoption of VMAT, commissioning and developing a quality assurance (QA) program continues to be a challenge especially in busy departments. These points indicate that a review of commissioning and quality assurance for IMRT is still very much needed. In this session, the development of an overall IMRT/VMAT QA program, the role of team members and on-going program functions will be described including aspects of both quality and safety. General issues and specifics of IMRT/VMAT commissioning and quality assurance will be covered. While the general principles of commissioning and QA apply to any device capable of intensity-modulation, specific examples will be provided for Elekta and Varian linear accelerators. Strategies for commission and useful checklists will be discussed as well as some differences between Elekta and Varian technologies. There will also be a focus on practical advice towards the implementation and on-going QA of linac-based IMRT and VMAT. Patient- specific QA strategies along with the comparison of different QA equipment and techniques will be presented. Lastly, differences will be highlighted between IMRT and VMAT for patient-specific QA.Learning Objectives:1. Understand approaches to IMRT/VMAT commissioning and QA2. Describe most relevant issues in patient-specific QA for IMRT/VMAT3. Discuss issues with IMRT /VMAT QA equipment and techniques.
    Medical Physics 06/2012; 39(6):3863. · 2.91 Impact Factor
  • Fuel and Energy Abstracts 10/2011; 81(2).
  • Fuel and Energy Abstracts 10/2011; 81(2).
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    ABSTRACT: Dose escalation with intensity-modulated radiation therapy (IMRT) for carcinoma of the prostate has augmented the need for accurate prostate localization prior to dose delivery. Daily planar kilovoltage (kV) imaging is a low-dose image-guidance technique that is prevalent among radiation oncologists. However, clinical outcomes evaluating the benefit of daily kV imaging are lacking. The purpose of this study was to report our clinical experience, including prostate motion and gastrointestinal (GI) and genitourinary (GU) toxicities, using this modality. A retrospective analysis of 100 patients treated consecutively between December 2005 and March 2008 with definitive external beam IMRT for T1c-T4 disease were included in this analysis. Prescription doses ranged from 74-78 Gy (median, 76) in 2 Gy fractions and were delivered following daily prostate localization using on-board kV imaging (OBI) to localize gold seed fiducial markers within the prostate. Acute and late toxicities were graded as per the NCI CTCAEv3.0. The median follow-up was 22 months. The magnitude and direction of prostate displacement and daily shifts in three axes are reported. Of note, 9.1% and 12.9% of prostate displacements were ≥ 5 mm in the anterior-posterior and superior-inferior directions, respectively. Acute grade 2 GI and GU events occurred in 11% and 39% of patients, respectively, however no grade 3 or higher acute GI or GU events were observed. Regarding late toxicity, 2% and 17% of patients developed grade 2 toxicities, and similarly no grade 3 or higher events had occurred by last follow-up. Thus, kV imaging detected a substantial amount of inter-fractional displacement and may help reduce toxicity profiles, especially high grade events, by improving the accuracy of dose delivery.
    Technology in cancer research & treatment 02/2011; 10(1):31-7. · 1.94 Impact Factor
  • Fuel and Energy Abstracts 01/2011; 81(2).
  • R. Rice, G. Kim, J. Wang, T. Pawlicki
    Medical Physics 01/2011; 38(6):3471-. · 2.91 Impact Factor
  • Medical Physics 01/2011; 38(6):3620-. · 2.91 Impact Factor
  • Fuel and Energy Abstracts 01/2011; 81(2).
  • J. Wang, K. Murphy, R. Rice, T. Pawlicki
    Medical Physics 01/2011; 38(6):3635-. · 2.91 Impact Factor
  • Fuel and Energy Abstracts 01/2011; 81(2).
  • Fuel and Energy Abstracts 11/2010; 78(3).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent articles in the New York Times have focused attention on catastrophic errors that can occur during radiation treatment. While the concern is particularly important for the IMRT treatment modality that uses a relatively high number of monitor units that, taken in total, can be lethal, there are many well known reports of serious incidents during conventional radiation therapy. The first talk in this session will set the scene through a general overview of the topic including a discussion of the relationship between quality and safety. This theme will continue with the second talk which will frame the problem of catastrophic error prevention as a special QA issue that should be considered as distinct from procedures aimed at avoiding dose deviations that can compromise the outcome of treatment in more subtle ways. Quality assurance strategies specifically designed to detect potentially catastrophic errors will also be discussed in this second talk relative to methodologies used to measure treatment plan quality in general. Two major tests will be considered in this review: 1) the patient‐specific end‐to‐end test for IMRT, and 2) and the imaging and treatment coordinate coincidence test stated in the IGRT Table V of the AAPM Task Group 142. The remaining four 20 minute talks will focus on four complementary approaches to error management. These are Root Cause Analysis, Incident Learning Systems, Failure Modes and Effects Analysis and Fault Tree Analysis. Each of these talks will follow a similar format of identifying the role and history of the particular strategy, an overview of the methodology, sample results and opportunities and challenges of implementing each technique.Learning Objectives:1. Present a connection between quality and safety.2. Discuss quality assurance strategies designed to prevent catastrophic errors.3. Introduce common error management techniques.
    Medical Physics 05/2010; 37(6):3424-3424. · 2.91 Impact Factor
  • Fuel and Energy Abstracts 01/2010; 78(3).
  • Medical Physics 01/2010; 37(6). · 2.91 Impact Factor
  • T. Pawlicki, M. Whitaker, G. Kim
    Medical Physics 01/2010; 37(6). · 2.91 Impact Factor
  • J. Wang, T. Pawlicki, R. Rice, A. Mundt, K. Murphy
    Medical Physics 01/2010; 37(6). · 2.91 Impact Factor

Publication Stats

869 Citations
167.00 Total Impact Points


  • 2007–2012
    • University of California, San Diego
      San Diego, California, United States
  • 1999–2003
    • Stanford Medicine
      • Department of Radiation Oncology
      Stanford, California, United States
    • Stanford University
      • • Department of Radiation Oncology
      • • Department of Medicine
      Stanford, CA, United States
  • 1996
    • Medical University of Ohio at Toledo
      Toledo, Ohio, United States
  • 1994–1996
    • West Virginia University
      Morgantown, West Virginia, United States
  • 1992
    • University of Pittsburgh
      • Department of Radiation Oncology
      Pittsburgh, PA, United States