[Organization and prerequisites for the delegation of dosimetry tasks]. / Partage des tâches avec les manipulateurs en électroradiologie médicale : organisation et prérequis pour la délégation des tâches de dosimétrie des plans de traitement.

The planning of irradiation treatments is a task of medical physics, based on the appropriate calculations of a dose distribution from radiation beams, virtually set up on a simulation software. This task is at the centre of the chain of treatment preparation: between the contouring phase and the objective definition, which are specialties of the radiation oncologist, and the joint validation of the treatment plan by the physician and the physicist. Historically, this task has been performed by the medical physicist, but can be delegated to other professionals, especially radiation technologists. The evolution of the techniques and procedures tends to a specialization of the skilled workers toward this new work of dosimetry specialist or treatment planning technician. In this paper, the training, relational and organizational aspects will be described to explain how the delegation of the tasks, in the context of treatment plan preparation between professionals can be set up with the highest level of quality and security for the patient treatment and with the respect of legal obligations and requirements of each profession.

[Systematic approach for dysfunctional analysis in radiotherapy]. / Démarche systématique d'analyse dysfonctionnelle en radiothérapie.

PURPOSE: We previously presented a systematic and structured approach to acquire an accurate functional model of the patient's process in radiotherapy. This approach relied on new functional structuring patterns, derived from system engineering and knowledge engineering. Additionally, we propose a complementary methodical process for the dysfunctional analysis of the obtained functional model. MATERIALS AND METHODS: The procedure is based on joint implementation of two qualitative methods named "Failure modes and effects analysis" (FMEA) and "Hazard and operability" (HazOp). RESULTS: All the technical, the human and the organizational dimensions of the patient's process are pooled in a unique, exhaustive and detailed dysfunctional analysis. The application of this systematic approach within a particular institution can precisely identify the risks incurred by patients in care, but also highlight the logical sequence between precursor events and incidents. CONCLUSION: The dysfunctional analysis presented in this document will be used for the development still in process of quantified risk models.

[Functional modeling for risk analysis in radiotherapy]. / Modélisation fonctionnelle adaptée à l'analyse des risques en radiothérapie.

PURPOSE: This document presents a systematic and structured approach for functional modeling for risk analysis in radiotherapy, aiming to reconcile the need, on one hand, for a method that can be applied generally and, on the other hand, for a method that provides a highly precise model. MATERIALS AND METHODS: The approach relies on new functional structuring patterns and flux analysis, derived from system engineering and knowledge engineering. RESULTS: The method affords strong support for the development of detailed models of the patient's process through a department of radiotherapy. Lack of structure of the actual process in a particular department may be easily identified leading to the development of specific procedures for the improvement of security. CONCLUSION: Modeling approach derived from engineering may be used for functional modeling for risk analysis in radiotherapy.

[Securitization of the bi-site radiotherapy activity as part of the resumption of treatments in the Hospital of Epinal by the team of Alexis Vautrin Nancy Cancer Center]. / Sécurisation de l'activité de radiothérapie bi-site dans le cadre de la reprise des traitements au centre hospitalier d'Epinal par l'équipe du centre Alexis-Vautrin de Nancy.

In February 2007, the radiation therapy department of the Jean Monnet Hospital in Epinal (France) has stopped the radiotherapy treatments after the discovery of a radiotherapy accident and bad practices leading to overexposure of patients between 1987 and 2006. The Regional Cancer Center "Centre Alexis Vautrin" in Nancy (France) was given the task of the new start of treatment activity. From February 2007 to January 2008, actions of training, updates of equipments and practices have been performed in the Epinal Hospital, guided by the quality approach, allowing the treatment of new patients in February 2008, with the radiation oncologists and the medical physicists of the Centre Alexis Vautrin, with the highest conditions of security and confidence.

[Safety and quality assurance management in radiation oncology "what is the role for qualiticians?": example of the Centre Alexis Vautrin]. / Management de la qualité et de la sécurité en radiothérapie "Quel rôle pour les qualiticiens ?": exemple au centre Alexis-Vautrin.

Since 2007, the Centre Alexis-Vautrin Cancer Institute in Nancy began its safety and quality assurance management policy in the department of radiation oncology. This development induced a collaborative workflow between the quality unit and the department of radiation oncology, with a definition of the responsibilities. The quality unit provides its methodology for the quality assurance, the professionals of the radiation oncology department their expertise. In parallel, a quality referee was nominated in the radiation oncology department to implement the projects for improvement, linked with the quality assurance unit, and under the control of the radiation oncology department staff.