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events but 13%do not monitor or monitor only partially
the implementation of these improvement measures. The
involvement of theManagement ofmedical establishments
in this area is essential andmust be maintained over the
long term.
5.3.3 Summary
To conclude, ASNhas observed continuous improvement
in the implementation of the quality and safety
management requirements in radiotherapy departments
since 2008 and considers that the findings established
at the end of 2014 confirm this analysis, while at the
same time underlining variability between centres,
particularly in seeing to the continuous improvement
of the documentary system. Although the quality systems
are increasing in number, the analysis of events shows
that the systems are not evaluated and do not take
practices sufficiently into account.
Risk management is now integrated in the radiotherapy
departments, with the internal listing of malfunctions
and their analysis being set up. But efforts must still
be made in monitoring the envisaged improvement
actions over time, as this is a vital step to ensure the
effectiveness of the measures taken.
The new techniques in radiotherapy
In August 2013, ASN asked the GPMED (Advisory Committee
of Experts on Medical Exposure) to issue recommendations
concerning the conditions of implementation of new
techniques in radiotherapy and the associated practices,
focusing in particular on the techniques of intensity-
modulated radiotherapy and stereotactic irradiation,
and on new treatment devices.
The opinion of the GPMED was delivered on 10th February
2015 and transmitted by ASN to the Ministry responsible for
Health, to the INCa and the HAS and to the learned societies,
requesting that the necessary actions corresponding to the
12 recommendations issued be defined and undertaken.
ASN will be particularly attentive to the monitoring of
these actions, especially those concerning the adaptation
of the means necessary to deploy these new techniques
and practices, the implementation of the clinical audit
procedures, the prospective collection of data concerning
the patients so that the benefits and the risks can be
assessed, and the reinforcement of patient involvement.
TO BE NOTED
RESULTS OF THE INDICATOR
concerning the management of risks and events (%)
Source: inspections ASN.
Internal record of notifications
Monitoring improvement actions
Search for improvement actions
Experience feedback committee
ESR notification procedure
Training in the notification and
identification of malfunctions
0
20
40
60
80
100
2013
2014
2012
2011
2010
314
CHAPTER 09:
MEDICAL USES OF IONISING RADIATION
ASN report on the state of nuclear safety and radiation protection in France in 2015