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Pourel N, Meyrieux C, Lisbona A. Quality/risk management system in radiotherapy: Changes afoot. Cancer Radiother 2021; 26:14-19. [PMID: 34953695 DOI: 10.1016/j.canrad.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The French sanitary and regulatory context in which radiotherapy centres are comprised is evolving. Risk and quality management systems are currently adapting to these evolutions. The French nuclear safety agency (ASN) decision of July 1st 2008 on quality assurance obligations in radiotherapy has reached 10 years of age, and the French high authority of health (HAS) certification system 20 years now. Mandatory tools needed for the improvement of quality and safety in healthcare are now well known. From now on, the focus of healthcare policies is oriented towards evaluation of efficiency of these new organisations designed following ASN and HAS nationwide guidelines.
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Affiliation(s)
- N Pourel
- Pôle radiothérapie, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France.
| | - C Meyrieux
- Département Qualité, Institut du cancer Avignon-Provence, 250, chemin de Baigne-Pieds, 84000 Avignon, France
| | - A Lisbona
- Département de physique médicale, Institut de cancérologie de l'Ouest centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
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Integrating Quality Tools and Methods to Analyze and Improve a Hospital Sterilization Process. Healthcare (Basel) 2021; 9:healthcare9050544. [PMID: 34066947 PMCID: PMC8148510 DOI: 10.3390/healthcare9050544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022] Open
Abstract
Healthcare facilities are facing major issues and challenges. Hospitals continuously search approaches to improve operations quality, optimize performance, and minimize costs. Specifically, an efficient hospital sterilization process (HSP) allows reusable medical devices (RMDs) to be more quickly available for healthcare activities. In this context, this paper describes an integrated approach developed to analyze HSP and to identify the most critical improvement actions. This proposed approach integrates four quality tools and techniques. Firstly, a structured analysis and design technique (SADT) methodology is applied to describe HSP as a hierarchy of activities and functions. Secondly, the failure modes and effects analysis (FMEA) method is used as a risk assessment step to determine which activity processes need careful attention. Thirdly, a cause–effect analysis technique is used as a tool to help identify all the possible improvement actions. Finally, priority improvement actions are proposed using the quality function deployment (QFD) method. To validate the proposed approach, a real sterilization process used at the maternity services of Hedi-Cheker Hospital in the governorate of Sfax, Tunisia, was fully studied. For this specific HSP, the proposed approach results showed that the two most critical activities were (1) improving the coordination between the sterilization service and the surgery block and (2) minimizing the average duration of the sterilization process to ensure the availability of RMDs in time.
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Mazeron JJ, Mornex F, Cosset JM, Eschwège F. [The 30th anniversary of SFRO, the French society of oncological radiotherapy]. Cancer Radiother 2021; 25:411-418. [PMID: 33875367 DOI: 10.1016/j.canrad.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The French society of oncological radiotherapy (Société française de radiothérapie oncologique, SFRO) was created in 1990. On the occasion of its thirtieth annual congress, in October 2019, a session was devoted to it, with the objective of exposing its functioning, its actions and its productions during these three decades during which radiotherapy and oncology have undergone unprecedented transformations. We propose in this article to outline the content of this session.
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Affiliation(s)
- J-J Mazeron
- Centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France.
| | - F Mornex
- Centre hospitalier Lyon-sud, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - J-M Cosset
- Centre de radiothérapie Charlebourg, groupe Amethyst, 92250 La Garenne-Colombes, France
| | - F Eschwège
- Centre Antoine-Béclère, 47, rue de la Colonie, 75013 Paris, France
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Shin D, Yoon M, Moon S, Jo Y, Seo J. Inter-fractional entrance dose monitoring as quality assurance using Gafchromic EBT3 film. J Cancer Res Ther 2021; 18:1152-1158. [DOI: 10.4103/jcrt.jcrt_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sarkar V, Paxton A, Kunz J, Szegedi M, Nelson G, Rassiah‐Szegedi P, Zhao H, Huang YJ, Su F, Salter BJ. A systematic evaluation of the error detection abilities of a new diode transmission detector. J Appl Clin Med Phys 2019; 20:122-132. [PMID: 31385436 PMCID: PMC6753730 DOI: 10.1002/acm2.12691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/19/2019] [Accepted: 07/20/2019] [Indexed: 02/02/2023] Open
Abstract
Transmission detectors meant to measure every beam delivered on a linear accelerator are now becoming available for monitoring the quality of the dose distribution delivered to the patient daily. The purpose of this work is to present results from a systematic evaluation of the error detection capabilities of one such detector, the Delta4 Discover. Existing patient treatment plans were modified through in‐house‐developed software to mimic various delivery errors that have been observed in the past. Errors included shifts in multileaf collimator leaf positions, changing the beam energy from what was planned, and a simulation of what would happen if the secondary collimator jaws did not track with the leaves as they moved. The study was done for simple 3D plans, static gantry intensity modulated radiation therapy plans as well as dynamic arc and volumetric modulated arc therapy (VMAT) plans. Baseline plans were delivered with both the Discover device and the Delta4 Phantom+ to establish baseline gamma pass rates. Modified plans were then delivered using the Discover only and the predicted change in gamma pass rate, as well as the detected leaf positions were evaluated. Leaf deviations as small as 0.5 mm for a static three‐dimensional field were detected, with this detection limit growing to 1 mm with more complex delivery modalities such as VMAT. The gamma pass rates dropped noticeably once the intentional leaf error introduced was greater than the distance‐to‐agreement criterion. The unit also demonstrated the desired drop in gamma pass rates of at least 20% when jaw tracking was intentionally disabled and when an incorrect energy was used for the delivery. With its ability to find errors intentionally introduced into delivered plans, the Discover shows promise of being a valuable, independent error detection tool that should serve to detect delivery errors that can occur during radiotherapy treatment.
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Affiliation(s)
| | | | | | | | | | | | - Hui Zhao
- University of UtahSalt Lake CityUTUSA
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Abstract
Quality and safety management have been implemented for many years in healthcare structures (hospitals treating cancer, private radiotherapy centres). Their structure and formalization have improved progressively over time. These recommendations aim at describing the link between quality and safety management through its organization scheme based on quality-safety policy, process approach, document management and quality measurement. Dedicated tools, such as experience feedback, a priori risk mapping, to-do-lists and check-lists are shown as examples and recommended as routine practice.
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Affiliation(s)
- N Pourel
- Pôle de radiothérapie, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France.
| | - C Meyrieux
- Pôle de radiothérapie, département qualité, institut Sainte-Catherine, 250, chemin de Baigne-Pieds, CS80005, 84918 Avignon cedex 9, France
| | - B Perrin
- Unité de radioprotection et physique médicale, pôle d'oncologie, centre hospitalier Pasteur, 39, avenue de la Liberté, 68024 Colmar cedex, France
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Mazeron R, Aguini N, Rivin Del Campo E, Dumas I, Gensse MC, Brusadin G, Lefkopoulos D, Deutsch E, Haie-Meder C. Implementation of the global risk analysis in pulsed-dose rate brachytherapy: methods and results. Cancer Radiother 2015; 19:89-97. [PMID: 25600666 DOI: 10.1016/j.canrad.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- R Mazeron
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France.
| | - N Aguini
- Quality and risk Assessment, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - E Rivin Del Campo
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - I Dumas
- Medical physics, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - M-C Gensse
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - G Brusadin
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - D Lefkopoulos
- Medical physics, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - E Deutsch
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
| | - C Haie-Meder
- Radiation Oncology, Gustave-Roussy Cancer Campus Grand Paris, 114, rue Édouard-Vaillant, 97805 Villejuif cedex, France
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Mazeron R, Aguini N, Rivin E, Baudré A, Bour MS, Dumas I, Hubert F, Lopes S, Desroches A, Deutsch E, Lefkopoulos D, Bourhis J. Improving safety in radiotherapy: The implementation of the Global Risk Analysis method. Radiother Oncol 2014; 112:205-11. [DOI: 10.1016/j.radonc.2014.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 08/01/2014] [Accepted: 08/27/2014] [Indexed: 11/26/2022]
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Mazeron R, Aguini N, Deutsch É. [Risk analysis in radiation therapy: state of the art]. Cancer Radiother 2013; 17:308-16, quiz 332. [PMID: 23787020 DOI: 10.1016/j.canrad.2013.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022]
Abstract
Five radiotherapy accidents, from which two serial, occurred in France from 2003 to 2007, led the authorities to establish a roadmap for securing radiotherapy. By analogy with industrial processes, a technical decision form the French Nuclear Safety Authority in 2008 requires radiotherapy professionals to conduct analyzes of risks to patients. The process of risk analysis had been tested in three pilot centers, before the occurrence of accidents, with the creation of cells feedback. The regulation now requires all radiotherapy services to have similar structures to collect precursor events, incidents and accidents, to perform analyzes following rigorous methods and to initiate corrective actions. At the same time, it is also required to conduct analyzes a priori, less intuitive, and usually require the help of a quality engineer, with the aim of reducing risk. The progressive implementation of these devices is part of an overall policy to improve the quality of radiotherapy. Since 2007, no radiotherapy accident was reported.
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Affiliation(s)
- R Mazeron
- Département de Radiothérapie, Institut de Cancérologie Gustave-Roussy, 114 rue Édouard-Vaillant, 94085 Villejuif cedex, France.
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