Hiromichi Ishiyama, MD^∗,∗, Nobuaki Shuto, RT^†, Tsuyoshi Terazaki, RT^†, Shigetoshi Noda, RT^†, Minoru Ishigami, RT^†, Katsunori Yogo, PhD^‡, Kazushige Hayakawa, MD^∗
∗Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
^† Division of Radiation Oncology, Kitasato University Hospital, Kanagawa, Japan
^‡ Division of Medical Physics, Hiroshima High-precision Radiotherapy Cancer Center, Hiroshima, Japan

We aimed to analyze risk factors for incidents occurring during the practice of external beam radiotherapy (EBRT) at a single Japanese center. Treatment data for EBRT from June 2014 to March 2017 were collected. Data from incident reports submitted during this period were reviewed. Near-miss cases were not included. Risk factors for incidents, including patient characteristics and treatment-related factors, were explored using uni- and multivariate analyses. Factors contributing to each incident were also retrospectively categorized according to the recommendations of the American Association of Physicists in Medicine (AAPM). A total of 2887 patients were treated during the study period, and 26 incidents occurred (0.90% per patient). Previous history of radiotherapy and large fraction size were identified as risk factors for incidents by univariate analysis. Only previous history of radiotherapy was detected as a risk factor in multivariate analysis. Identified categories of contributing factors were human behavior (50.0%), communication (40.6%), and technical (9.4%). The incident rate of EBRT was 0.90% per patient in our institution. Previous history of radiotherapy and large fraction size were detected as risk factors for incidents. Human behavior and communication errors were identified as contributing factors for most incidents.