313 / 536
•
the risks run by the patients are analysed in 100%
of the centres inspected in 2014 but the analysis is
updated in only 65% of the centres, even though this
updating is essential, especially when new techniques
are introduced.
Noting reluctance on the part of the centres to embrace
these risk analyses, ASNhas produced - in collaboration
with radiotherapy professionals - an assessment of
the difficulties encountered with a view to issuing
recommendations to facilitate applicationof this procedure.
An IRSN appraisal requested by ASNwas carried out in
2014 and recommendations were published in 2015. This
appraisal underlines the need to improve the assistance
given to radiotherapy units, to reduce the complexity
of the risk analyses and to improve the feasibility and
practicality of the risk analyses.
The figure below illustrates the progress in the approach
to the management of treatment safety and quality since
2010.
Control of treatment procedures
Based on the analysis of the events notified to ASN,
inspections have targeted certain treatment steps in order to
verify the existence of procedures formalising the practices
and their effective implementation. In 2014, treatment
preparation (computed tomography and dosimetry) and
the verification of patient positioning during treatment
were examined.
It was observed that:
•
93%of the inspected centres have devised a procedure
for setting up the patient under the scanner for the
principal locations treated;
•
98% of the inspected centres have the dosimetric
treatment plan approved by the medical physicist and
the radiation oncologist before delivering the treatment;
•
98% of the inspected centres check the position by
imaging at least once per week. Progress is nevertheless
requiredwith regard to themethods of performing and
supervising the positioning verifications, as only 76%of
the centres have formalised the criteria for determining
when a medical opinion must be requested.
Management of risks
and addressing malfunctions
Internal listing of malfunctions has been put in place in
virtually all the centres, given that 98% of the inspected
centres have such a list and use it.
ASNobserved in 2014 that 88%of the inspected centres
have an organisational set-up enabling them to regularly
bring togethermultidisciplinary skills to analyse significant
radiation protection events. 97% of the centres have
identified improvement measures after analysing the
DEVELOPMENT OF CRITERIA
since 2010 concerning the deployment of section 1 of ASN resolution 2008-DC-0103 ASN (%)
Source: inspections ASN.
Existence of process mapping
Existence of a treatment interruption
or continuation procedure
Quality document
management procedure
Existence of an analysis of the risks
run by the patients
Appointment of the operational manager
of the patient care safety and quality
management system
0
20
40
60
80
100
2013
2014
2012
2011
2010
313
CHAPTER 09:
MEDICAL USES OF IONISING RADIATION
ASN report on the state of nuclear safety and radiation protection in France in 2015