提升頭頸癌患者接受放射治療過程之肩膀位置再現性：運用品質管理循環

TO IMPROVE THE SHOULDER POSITION REPRODUCIBILITY OF PATIENTS UNDERGOING RADIOTHERAPY FOR HEAD AND NECK CANCER: APPLICATION OF PDCA MANAGEMENT CYCLE

楊登凱(Teng-Kai Yang) ； 呂彥德(Yen-De Lu) ； 王姿雯(Tzu-Wen Wang) ； 王玉儒(Yu-Ru Wang) ； 蔡仁豪(Ren-Hau Tsai) ； 王銘志(Ming-Chih Wang)

《放射治療與腫瘤學》 25卷1期 (2018/03) Pp. 33-42

https://doi.org/10.6316/TRO/201825(1)33

摘要

目的：放射治療頭頸癌患者，會製作頭頸部固定面具（Head and Neck immobilization Mask），但肩膀的位置往往沒有固定性。臨床使用導航式螺旋刀（TomoTherapy）治療，進行影像導航比對時，發現肩膀位置與原始治療計劃位置不同。本研究希望藉由品管圈（Quality Control Circle, QCC）之品質管理循環（Plan-Do-Check-Action, PDCA），找出合適改善對策，提升頭頸癌患者接受放射治療過程之肩膀位置再現性。材料與方法：於2014年3月至12月期間共收集了184人次，使用導航式螺旋刀執行治療頭頸癌病患之電腦斷層影像（MVCT）。以回溯的方式，分析患者治療前擺位之肩膀位移，做為改善前資料之依據。並於2014年1月1日至12月31日，運用品管圈之手法，進行「提升頭頸癌患者接受放射治療過程之肩膀位置再現性」品質改善活動。結果：兩側肩膀小於5 mm位移率，由改善前的58.69 %提升至94.44 %。兩側肩膀大於10 mm位移率，由改善前的11.05 % 降低至0 %。並持續性的追蹤其效果確認，也顯示能持續維持高於目標值，因此足以代表此次品質改善之對策，能提升頭頸癌患者之肩膀位置再現性。結論：運用品質管理循環，能有效發現問題、改善問題，並解決問題與建立作業標準化。此次品質改善之對策，製作出可適用於不同病患手拉位置長度，能固定與量化肩膀位置之肩膀固定器（shoulder retractor），提高頭頸癌病患肩膀位置再現性。

關鍵字

導航式螺旋刀 ； 肩膀位移 ； 品管圈 ； 品質管理循環

並列摘要

Purpose: While delivering radiation beam to a head and neck cancer patient, a thermoplastic mask is used to fix the position of head and neck region to ensure the reproducibility of head and neck posture during the whole treatment process. However, the location of the shoulders is not accurate according to comparison of image navigation in the clinical treatment. In this study, we hoped to improve the shoulder position reproducibility of patients undergoing radiotherapy for head and neck cancer by using the plan-do-check-action (PDCA) of quality control circle (QCC). Material and Method: From February 2014 to December 2014 in TomoTherapy. Daily shoulder position variation relative to treatment isocenter was quantified using MVCT-based bony alignment for 184 images with head and neck patients. Shoulder position variation was evaluated with daily CT scans from an MVCT scan. From January 1, 2014 to December 31, 2014, We use of quality control of the way, to improve the shoulder position reproducibility of patients undergoing radiotherapy for head and neck cancer Results: The shoulder displacement less than 5 mm rate was 58.69% at the beginning. The rate of ＜ 5 mm shoulder displacement was 90% after intervention. The shoulder less than 10 mm displacement rate was 88.95%. The displacement was 100% ＜10 mm after intervention for improvement. It was found that the result of plan-do-check-action (PDCA) of quality control circle (QCC) could be maintained after keeping track of the shoulder displacement. Conclusion: The application of quality control circle can effectively identify problems, improve the problem, and solve the problem and the establish of Standard Operating Procedures (SOP). The shoulder retractor can be applied to different patients with hand-pull position, and can be quantified the shoulder position to achieve higher reproducibility of the head and neck cancer shoulder position.

並列關鍵字

TomoTherapy ； Shoulder displacement ； Quality Control Circle (QCC) ； Plan-Do-Check-Action ； (PDCA)