Radiotherapy risk management: Going beyond the concept of safety barriers

Abstract

The traditional approaches to safety in risk activities have been applied to radiotherapy following the occurrence of serious accidents. This strategy is based on the characterization of specific risks and the definition of preventive and protective measures, particularly for the implementation of safety barriers. Evaluating the performance of safety barriers makes it possible, in theory, to determine the level of risk control. This article presents a literature review that highlights the limits of the safety barrier concept. To overcome these limitations, we then introduce the notion of “activities contributing to safety” (ACS). This concept allows us to better take into account the managerial, contextual, organizational and human dimensions of safety and to promote risk control through a more realistic approach.

La nécessaire évolution de la préparation et de la gestion post-accidentelle nucléaire / The necessary development of post-nuclear accident management preparedness

“…In addition, preparation for the prevention and management of radiotherapy accidents remain a subject of major interest for Radioprotection (Thellier et al, 2021). On this topic we are pleased to publish in this issue an article of great interest by Özbay et al, entitled "Probabilistic risk assessment of radiotherapy" (Özbay et al, 2022).…”

Vers de nouvelles recommandations en radioprotection : la CIPR en marche / Towards new recommendations in radiological protection: ICRP on the move

“…La médecine est un domaine majeur d'exposition aux rayonnements ionisants avec des enjeux de radioprotection importants pour les patients. En radiothérapie, outre l'évaluation probabiliste des risques (Thellier et al, 2021;Özbay et al, 2022), les modalités d'hypofractionnement avec des doses plus élevées par fraction soulèvent de nouvelles questions de radiobiologie (Bertho et al, 2021). En radiodiagnostic, le risque de leucémie associé aux examens scanners est de nouveau examiné (Asgari et al, 2021) alors que les résultats de la grande étude épidémiologique européenne EPI-CT concernant un excès de tumeurs cérébrales et de leucémies chez l'enfant sont attendus.…”

“…Medicine is a major field of exposure to ionizing radiation with significant radiological protection issues. In radiation therapy, besides the probabilistic risk assessment (Thellier et al, 2021;Özbay et al, 2022), the hypo fractionation modalities with higher dose per fraction raises new radiation biology issues (Bertho et al, 2021). In diagnostic radiology, the risk of leukemia associated with CT examinations is again examined (Asgari et al, 2021) while the results of the large European epidemiologic study EPI-CT study regarding an excess of brain tumors and leukemia in children are pending.…”