ESTRO 2020 Abstract book

S1137 ESTRO 2020

It was possible to propose risk management stages, as well as a way of documenting the risk management procedure, for a specific therapeutic method which is IOERT therapy using mobile accelerators. PO-1947 ARIA 15 Visual care Path for quality assurance of radiation oncology course F. Fragnoli 1 , I. Bonaparte 1 , L. Branà 1 , A. Aga 1 , M. De Masi 1 , A. Ciocia 1 , C. Indellicati 1 , R. Parabita 1 , G. Sanfrancesco 1 , C. De Pascali 1 , F. Berloco 1 , M. Caliandro 1 , F. Gregucci 1 , A. Surgo 1 , R. Carbonara 1 , A. Fiorentino 1 1 Regional General Hospital Miulli, Radiation Oncology, Acquaviva delle fonti, Italy Purpose or Objective Aria 15 Visual Care Path (VCP) is a workflow tool for radiotherapy oncology (RO) course. Aim of this study was to quantify the impact of VCP on quality assurance in terms of efficiency and safety, for patient’s course in Radiotherapy Material and Methods The multidisciplinary quality improvement team (Radiation oncologist, physicists and technicians) reviewed the entire process of patient care and constructed VCP modules to chart serial and parallel events from CT simulation to treatment completion. The RO course was defined as follow: CT simulation, contouring within 2 days, dose prescription in 1 day, planning within 2 days, plan approval 1 day. Following this organization, patients start RO treatment within 8 das. Data on timeliness of task completion were collected for all patients. Errors detected during a physics plan check were also monitored. Results From July 2019 to September 2019, 165 patients were treated and analyzed. 123 patients (75%) started treatment within 8 days, while 38 patients (23%) started treatment in a time ranged from 9 to 16 days; and only 4 patients (2%) started after 19-24 days. The reasons of Start delay for 42 patients were as follow: logistic/organization reasons for 16 patients (transport problems and festivity issue); clinical reasons for 26 patients (further instrumental investigations or radiological examinations, concurrent chemotherapy or inadequate physical condition of the patient). Analyzing the VCP, the activities that took a longer time were the phase of contouring and planning, with an average number of days of 5 and 4 days, respectively. The defect rate (ratio of plans with errors to the total number of plans checked by a physicist) was null, in fact no errors were found for all the patients analyzed, neither during the planning phase, nor during the treatment delivery phase. A satisfaction questionnaire was also submitted to the members of the staff regarding this instrument and all responded positively, both for the possibility offered by the VCP to simplify the workflow, and for its ease and immediacy in use. Conclusion Implementation of the VCP in our department improved workflow efficiency, reduced the number of errors, and was very well received within the department.

The RTT's were technical well prepared at the patient's first treatment, and expressed it as very positive to be able to focus more on the patient's needs. On the basis on the results the instructions for treatment in the clinic was revised. Conclusion The dry runs were very important due to patient safety, to minimize time at first treatment and to gain experiences for future treatment plans. Dry runs are now implemented as a standard in the clinic on all plans before first treatment. PO-1946 Risk management for intraoperative electron radiotherapy accelerators A. Misiarz 1 , M. Kruszyna-Mochalska 2 , M. Bijok 3 , B. Pawłowski 2 , K. Kosiński 1 , J. Pracz 1 , J. Malicki 4 , P. Kukołowicz 3 1 National Centre for Nulcear Research, NCBJ Nuclear Equipment Division HITEC, Otwock-Swierk, Poland ; 2 Greater Poland Cancer Centre, Department of Medical Physics, Poznań, Poland ; 3 Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Medical Physics, Warszawa, Poland ; 4 University of Medical Sciences, Department of Electroradiology, Poznań, Poland Purpose or Objective Intraoperative electron radiotherapy (IOERT) is a technique enabling to deliver a high dose of ionizing radiation in a single session directly to the surgically exposed organ or tumor bed with the use of a mobile accelerator. Due to the specific features of the treatment procedure using an intraoperative accelerator compared to a conventional linear accelerator or performing only tumor resection, it is necessary to develop a dedicated risk analysis and management program. The purpose of this study was to develop risk management recommendations for IOERT that would apply to three types of accelerators. Material and Methods Two types of accelerators for IOERT are currently used clinically in Poland (Mobetron, IntraOp and Novac11, Sordina), while the third (IntralineIOERT, HITEC ZdAJ) built by the National Centre for Nuclear Research in Poland, is being prepared for clinical use. In intraoperative radiotherapy procedure, actions are taken that are not taken in radiotherapy carried out using conventional therapeutic devices or only performing tumor resection operations. These differences mean that for intraoperative therapy a detailed risk analysis is necessary. Irradiation using that method can be performed only at a specific time, associated with the surgery, which significantly affects the existing risks. From the various methods presented in the literature, the authors of this study focused on the FMEA (Failure Mode and Effects Analysis) method. It is often used due to its universality and possibility of use for various cases of risk analysis. The method consists in establishing the causal relationships of errors in various processes, successively eliminating sources of errors and minimizing the risk associated with them Results The authors divided the study into several parts required by ISO 1497; 2012 and ISO 31000; 2009. First, the identification of hazards was discussed, then attention was paid to the possibilities of risk assessment, and ended with a description of how to document and manage risk. As part of the case study, the authors noticed unique, distinctive risks that do not occur when working in the operating room, but are related only to the IOERT procedure. An example may be mechanical damage to both equipment and people in the operating room by a moving device or inability to carry out the procedure in the absence of cooling, or or exposure of persons to radiation. Conclusion