[The quality manager in radiation therapy: Evolution of the role, presentation of a French national Survey]. / Le responsable qualité en radiothérapie : évolution du rôle, présentation d'une enquête nationale.

PURPOSE: Review the role of the quality manager 15 years after ASN Decision 2008-DC-103 and 10 years after the creation of the Association française de la qualité et sécurité en radiothérapie (AFQSR), taking into account the new regulatory framework introduced by ASN Decisions 2021-DC-708 and 2019-DC-660. MATERIALS AND METHODS: a survey was drawn up and distributed to members of the French association for quality and safety in radiotherapy. RESULTS: The role of the quality manager in radiotherapy is one of the pillars of the quality/safety approach introduced by ASN Decision 2008-DC-103. CONCLUSION: The hierarchical position of the quality manager needs to be better defined, as does the notion of authority. The time and resources allocated to the function and to the quality/safety approach also need to be adapted, as these are the main factors of tension identified by the survey. The publication of ASN Decision 2019-DC-660 has extended the scope of the quality manager to include imaging in several centers.

[Radiation TherapisTs Radiographer (RTTs) and risk management in radiotherapy: An international survey]. / Manipulateurs en électroradiologie et gestion des risques en radiothérapie : présentation des résultats d'une enquête internationale.

PURPOSE: In order to study the role perception and the effective involvement of Radiation TherapisTs (RTTs) in risk management in radiotherapy, a survey was developed and distributed in five countries (France, Switzerland, Belgium, Ireland, the Netherlands). MATERIALS AND METHODS: The article presents the results of this survey and the comparison between the different countries. RESULTS: Overall, the results of the survey show a good involvement and perception of the RTTs around the risk management approach, although training in this area has yet to be systematized. CONCLUSION: Although with differences in the results between the participating countries, the survey seems to highlight the deployment of preventive actions that are evaluated as not very effective by the respondents and by the international scientific literature.

[Impact of a positive coronavirus diagnostic test on the radiotherapy patient journey at Gustave-Roussy institute]. / Impact d'un test de diagnostic du coronavirus positif sur le parcours du patient en radiothérapie à l'institut Gustave-Roussy.

PURPOSE: The coronavirus disease 2019 (COVID-19) epidemic continues to spread exponentially around the world. Cancer patients have a higher risk of commorbidity than the rest of the population. Radiotherapy departments are actively involved in the management of these patients, whether they have COVID or not, and it is recognized that the time taken to take charge and the continuity of treatment have a prognostic impact. The main objective was to assess the impact of the coronavirus on the treatment times of patients undergoing radiotherapy. MATERIAL AND METHODS: This retrospective study was conducted in the radiotherapy department of Gustave-Roussy institute (France) during the period from March 3, 2020 to January 12, 2021. Organizational changes, patient care times between the day of the scan and the last radiotherapy session as well as the time taken to take charge of patients between the first session and the last radiotherapy session has been studied. RESULTS: A total of 1183 patients were included, among which 60 had COVID-19. Patients were divided into four categories. Treatment times of patients who did not have COVID-19 and those of patients who did were not statistically significantly different. CONCLUSION: The organization of the radiotherapy department at the Gustave-Roussy institute is based on several points: carrying out preventive screening tests, protecting staff and patients and reorganizing the patient circuit. Thanks to the performance of diagnostic tests and the implementation of a specific workflow for patients with COVID, we ensure the continuity of patient treatment in complete safety without impacting treatment times.

[Application of a new methodology of a priori risk analysis in a radiotherapy department]. / Application d'une nouvelle méthodologie d'analyse de risques a priori dans un service de radiothérapie.

Since 2017, IRSN has been developing a new proactive risk analysis method. The Work Complexity Sharing and Exploration Spaces (EPECT in French) were tested for the first time in 2020 in the radiotherapy department of the Gustave Roussy Institute. The EPECT method makes it possible to anchor the analysis of risks incurred by patients in daily work situations and to involve the top management. The time required to involve the teams is comparable to or even less than that required for a conventional risk analysis. The cost/benefit ratio of the method seems to be advantageous because it provides access to numerous information on daily activities, which makes it possible to improve the safety of patient care in radiotherapy. The information gathered allows relevant actions to be envisaged at both the technical and organizational levels, and to be linked to departmental projects.

[Retrospective study on the intensification of hypofractionated radiotherapy: The organizational change]. / Étude rétrospective sur l'intensification des pratiques de radiothérapie hypofractionnée : le virage organisationnel.

PURPOSE: External radiotherapy process is a chain of steps in which each of them is carried out only if the previous one has been completed. The development of hypofractionation practices in recent years tends to increase the workload of the stages of preparation for irradiation and to decrease the number of fractions per patient. The purpose of this retrospective study is to analyze the evolution of these practices in a single centre and to assess the organizational issues involved. MATERIAL AND METHODS: All radiation therapy records management data were extracted from the Radiation Therapy Information System. Radiotherapy sessions were identified by patient and by ICD (International Classification of Diseases) code. The filling rate of the treatment equipment was calculated using actual data from the radiotherapy department. RESULTS: From 2015 to 2019, there was an increase in the number of scans (+16%), the number of patients treated (+11.6%) and the volume of hours available for treatment (+12%). Also, there was a decrease in the total number of fractions (-5%), in the average number of fractions performed per treatment sequence (-19%), in the occupancy rate of the machines (-7%) and in the average number of fractions performed per patient treated for malignant tumours of the bronchi and lung (-38%), digestive organs (-37%), secondary (-19%) breast (-15%) and prostate (-15%). The number of fractions administered per treatment sequence between 2015 and 2019 decreased significantly for patients in age groups [20-69] (P<0.001) and [>70] (P<0.001). CONCLUSION: A paradox appears between the increase in the total number of patients treated and the decrease in the loading rate of linacs. This shift of workload has an impact on the quality and safety of care and on the organizational and investment strategies. It also has an economic impact where the model of reimbursement is based on per fraction pricing. A reorganization of radiotherapy services is inevitable.

[Radiotherapy quality and risk manager role optimization in 2017]. / Optimisation du rôle du responsable qualité­gestion des risques au sein des services de radiothérapie en 2017.

The quality and risk manager works in a regulated framework, which delimits its missions. Nevertheless, the variety among the centers generates heterogeneous situations regarding the positioning and the range of action. A well-defined framework is needed in order to ratify the legitimacy and the recognition of quality and risk manager's main function.

[Implementation of "never events" checklists in a radiotherapy information system]. / Mise en œuvre de listes de contrôle « never events ¼ dans le système d'information en radiothérapie.

In order to reduce the incidence of major accidents during external radiotherapy treatment, "never events" checklists have been incorporated into the "record and verify" system. This article details this process. Prospects for improvement are also proposed, including a peer-to-peer audit on the use of checklists and the availability of the radiotherapy information system manufacturer to collaborate in this process to secure the patients' journey.

Implementation of the global risk analysis in pulsed-dose rate brachytherapy: methods and results.

PURPOSE: To report the application of the global risk analysis (GRA) in the pulsed-dose rate (PDR) brachytherapy workflow. MATERIAL AND METHODS: Analyses were led by a multidisciplinary working group established within the unit with the guidance of a quality engineer. First, a mapping of hazardous situations was developed as a result of interactions between the patient workflow for a treatment using PDR brachytherapy split into 51 sub-phases with a comprehensive list of the hazards that he/she faces (44). Interactions, when relevant, were sorted by level of priority: to be treated immediately, secondarily (the group is not entitled to treat the situation), or later (safe situation). Secondly, for each high priority dangerous situation, scenarios were developed to anticipate their potential consequences. Criticality was assessed, using likelihood and severity scales and a matrix, which allocated risks into categories: acceptable (C1), tolerable under control (C2) and unacceptable (C3). Then, corrective actions were proposed and planned when relevant, after assessment of their feasibility with a scale of effort. Finally, the criticality of the scenarios was reevaluated, taking into account the implementation of these actions, leading to a residual risk mapping, which could trigger additional proposals of actions. RESULTS: Two thousand one hundred and eighty-four potential interactions between the list of hazards and the workflow were analyzed. Mapping of dangerous situations identified 213 relevant interactions, from which 61 were considered with high priority. One hundred and twenty-six scenarios were generated: 68 with a low criticality (74.3%), 58 with an intermediate score (25.7%). No scenario with the highest criticality was individualized. Twenty-one corrective actions were planned. Mapping of residual risk resulted in the disappearance of most C2 risks, leaving 5 C2 scenarios (4%), for which four monitoring indicators were implemented in addition to the corrected actions decided on. CONCLUSION: The implementation of the GRA appeared feasible, and led to implement 21 corrective actions, based on scenarios and not on incidents.