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Abstract: Objectives: A national survey was conducted among the radiation oncology residents about their clinical activities and responsibilities. The aim was to evaluate the clinical workload and to assess how medical tasks are delegated and supervised. Materials and methods: A first questionnaire was administered to radiation oncology residents during a national course. A second questionnaire was mailed to 59 heads of departments. Results: The response rate was 62% for radiation oncology residents (99 questionnaires) and 51% for heads of department (30). Eighteen heads of department (64%) declared having written specifications describing the residents’ clinical tasks and roles, while only 31 radiation oncology residents (34%) knew about such a document (P =0.009). A majority of residents were satisfied with the amount of medical tasks that were delegated to them. Older residents complained about insufficient exposure to new patient's consultation, treatment planning and portal images validation. The variations observed between departments may induce heterogeneous trainings and should be addressed specifically. Conclusion: National specifications are necessary to reduce heterogeneities in training, and to insure that the residents’ training covers all the professional skills required to practice radiation oncology. A frame endorsed by academic and professional societies would also clarify the responsibilities of both residents and seniors. [Copyright &y& Elsevier]

Abstract: In mid-2004, following a Mission nationale d’expertise et d’audits hospitaliers (MeaH) proposal, three voluntary cancer centres started setting up a safety procedure in radiotherapy. Their work made it possible to single out the need to continue elaborating a repository, aiming at a “minimal written reference”, to take into account the human factor as one of the four families of factors contributing to a systemic deviation and to build collectively, in radiotherapy departments, the experience feedback committee (comité de retour d’expérience [Crex]). Formalizing a comité de retour d’expérience is unavoidable in any safety-management system (SMM or MGS). The comité de retour d’expérience enables every active member of a department to listen to any of the events of the month (incidents and precursors), to select the event which will be under scrutiny for the next systemic analysis (Orion© method) and above all to choose the most appropriate correcting action and ensure its proper implementation. That approach has been approved and then acknowledged by the Autorité de sûreté nucléaire (ASN) before being extended to the other radiotherapy departments. The use of the comité de retour d’expérience, which is a safety management tool, should not be limited to a local circle of insiders, but shared to benefit everybody. Putting comité de retour d’expérience together – a move that was hoped for and brought up as soon as the tool was created – is now being implemented. Several initiatives have already permitted to assess its collective interest; other steps have yet to be taken to enable a true collective sharing of experience. On this basis, the definition of quality/safety practices in radiotherapy will allow the professionals to implement clinical audits in 2012. [ABSTRACT FROM AUTHOR]

Abstract: In February 2007, the radiation therapy department of the Jean Monnet Hospital in Épinal (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 Épinal 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. [Copyright &y& Elsevier]

Abstract: The objective was the drafting of a practical document intended for radiotherapists and radiophysicists, describing the technique of irradiation of a non small cell bronchial cancer. The good practices concern the care of patients affected by bronchial cancer localized in the thorax and inoperable or patients who must undergo postoperative irradiation. The document has been developed according to a methodology aiming to join the current scientific data from an analysis of the literature on the subject and the assessment of radiotherapists, radiophysicists, lung specialists and methodologists from Rhône-Alpes area. From the stages necessary for the good progress of a radiotherapy, the writers of this document proposed common definitions concerning the centering and the location of the zone to be treated, the calculation of the dose distribution, the preparation of the patient for the treatment, the treatment and the surveillance during the treatment. The recommendations of this guide took into account the peculiarities bound to the nature of the treated region and more particularly the lung heterogeneity, respiratory movements and the radiosensibility of healthy lung tissue. Even if the technical aspect of the radiotherapy was particularly developed, the interest accorded to patient information takes on all its importance for a therapeutic coverage of quality. The authors of the document wished that this Guide of Good Practices, which will be regularly updated, helps the radiotherapists and allows them to harmonize their practices. [Copyright &y& Elsevier]

Abstract: Radiotherapy for bone metastases represents an important part of daily practice in our departments of radiotherapy. Majority of treatments deliver either one fraction (6 to 10Gy) or multifractions mainly using 30Gy in ten fractions. In the past decade, several randomized trials aimed to determine the optimal scheme of radiotherapy in this setting. In the present review, the efficacy of radiotherapy on bone metastases will be evaluated using the following parameters: the partial or complete responses on pain, the reduction of antalgic intake, bone recalcification, and need for reirradiation. Other parameters must also be considered, such as the primary site, number of metastasis, performance status, overall prognosis and side effects of radiotherapy. [Copyright &y& Elsevier]

Abstract: In medicine, as in oncological radiotherapy, as elsewhere, the precept of quality has no meaning if it is not defined. In France as everywhere radiotherapy has its forces and its weaknesses. As in every country, its future seems assured by its character cost effective as by its capacity to make progress in the triple point of view of its equipment, its professions and its organization. However, the French radiotherapy is in crisis. The professionals saw clearly. For more than 10 years they had recalled the medical authorities to their responsibilities concerning the demographic trends for the radiotherapists and the physicists, the renovation of the equipment, the modernization of the organizations, the promotion of the evaluation of procedures and outcomes and the development of a greater fairness in the financings. But the delay taken, the setting under pressure of the professionals by the State, its services, its agencies and the media following the recent accidents cause numerous perverse effects and worried the staff. The accident of Épinal was the starting fact of an effort of professionalisation of the risk management, but also of a disturbed period favourable with a certain confusion of minds, discouragement and protective behaviors. The risks felt by the professionals then seem especially to come from the authorities and the media. It appears that the topic of quality is at the center of all these speeches. Under this vocable, it is in fact the respect of the procedures related to the requirement of security which is privileged by the State and its representatives. The apparent security seems to override the real quality of the practices. Thus, time came for a clarification of the quality and security concepts, of organizations which contribute to it and for the development of a clear strategy bringing together the interprofessionnal actors. In this context, the implication of the College and especially of the Société française de radiothérapie oncologique is a requirement. [Copyright &y& Elsevier]