A study for the application of prospective approaches for safety assessment in new radiotherapy techniques

Modern and advanced planning and delivery technologies and techniques, recently introduced in radiation therapy for improving the treatment outcome, call for new challenges in terms of radiological protection of the patient and risk management of potential accidental exposure. The increased complexity related to these technological and process changes, places indeed new demands on quality assurance programmes and new attitudes and approaches of safety culture. In particular, prospective techniques for risk assessment in modern radiotherapy practices are recommended. A research project aimed to study these aspects and to sensitize the Italian scientific community in the use of prospective approaches has been recently launched by a working group of the Italian Association for Medical Physics (AIFM). In the first phase of the project intraoperative radiation therapy (IORT) practices carried out with mobile electron linear accelerators are considered. Process flow diagrams describing the activities, the instruments and the adopted procedures are properly developed in view of the identification of possible failure modes and the assessment and management of the associated risk. The methods and the analyses performed during this first phase are presented in this work. In a second phase, similar approaches will be considered and applyed for the risk assessment in other modern radiation therapy techniques, including hadrontherapy.