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Discovery and impact of the accident
BrainLAB* discovered that the measurement files did not match up with
those at other comparable centres, during a worldwide intercomparison
study
Treatment based on the incorrect data went on for a year (Apr
´
06 –
Apr
´
07)
All patients treated with microMLC were affected (145 of 172 stereotactic
patients)
The dosimetric impact was evaluated as small in most cases, with 6 patients
identified for whom over 5% of the volume of healthy organs may have been
affected by dose exceeding limits
7
2016-10-05
T Knöös
*
It should be noted that the company does not
validate or hold any responsibility for local
measurements or implementation