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] [What about the content of this article? (0)] [Affiliation(s)] [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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