Use of Lean Tools and Methods, Failure Mode and Effects Analysis and Automation to Improve the Radiotherapy Linear Accelerator Quality Assurance Process

  • Nicole Jessop

Student thesis: Unknown


Introduction Lean philosophy focuses on continuously improving processes by eliminating waste, improving standardisation and efficiency, and creating more reliable outputs. Although Lean tools and thinking are widely used in manufacturing they are rarely used in Radiotherapy. Other quality improvement tools such as Failure Mode and Effects Analysis and Process Mapping are also not widely utilised, despite being advocated by the American Association of Physics in Medicine. This quality improvement project used Lean and quality improvement tools and methods to improve the linear accelerator QA process at Peterborough City Hospital. Method A Process Map was created for the linear accelerator QA process with input from the physics team. This was then discussed at a process mapping workshop and sixteen different issues were identified. Some of these issues were quick to rectify but others required further investigation leading to a number of individual quality improvement projects. Root Cause Analysis (Five Whys and Fishbone diagrams) was used to ascertain the root cause of the some of the issues. Other problems required further information from audits and Failure Modes and Effects Analysis. An evaluation of automatic QA software tools (MPC, IBA myQA Machines and SunCHECK machine) was carried out to assess the benefits and drawbacks of such software tools. In addition to this, Lean tools such as the 5S and identification and elimination of waste were used to improve the QA process. Plan-Do-Check-Act (PDCA) cycles were performed and repeated where necessary to arrive at an optimal solution. These individual quality improvements and changes together made up the linear accelerator QA process quality improvement project. Results The wastes of motion, inventory, over production, waiting and defects were identified and minimised or eliminated. In addition to this, Linear accelerator machine time savings totalling 288 hours (29 working days) were achieved by changing the scheduling of the QA to avoid redundant time. Changes to the QA scheduling and recording of incomplete QA has reduced the missed monthly QA by 13% overall, the monthly photon and electron output QA by 26%, and the weekly QA by 7%.
Date of Award1 Aug 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorGeoffrey Budgell (Supervisor)


  • Quality Improvement
  • Radiotherapy
  • Linear Accelerator
  • Lean

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