title: Improving safety in radiotherapy: the implementation of the Global Risk Analysis method.
abstract: OBJECTIVE
  To report the application of the Global Risk Analysis (GRA), an innovative proactive risk analysis method, to a radiotherapy department.
  
  
  METHODS
  Analyses were conducted by a multidisciplinary working group with the support of a quality engineer. First, a mapping of hazardous situations was developed. For this, a double entry table was filled in, crossing the process of patient care divided into steps with a comprehensive list of pre-established hazards. The cells of the table represented interactions, which were, when relevant, considered as dangerous situations and then sorted by level of priority. For each high priority dangerous situation, scenarios were developed. Their criticality was assessed, using likelihood and severity scales, and a criticality matrix was used to allocate them into categories: acceptable (C1), tolerable (C2) and unacceptable (C3). Corrective actions were planned when relevant. Afterward, the criticality of the scenarios was reevaluated, leading to a residual risk mapping.
  
  
  RESULTS
  The number of high priority dangerous situations to analyze was 78, for which 205 scenarios were generated: 95 C1, 98 C2, and 12 C3 scenarios. Twenty-two corrective actions were planned. Mapping of residual risk resulted in the disappearance of C3 risks, leaving 18 C2 scenarios, for which six monitoring indicators were implemented.
  
  
  CONCLUSIONS
  The implementation of the GRA appeared feasible and led to the implementation of 22 corrective actions based on scenarios, without the occurrence of any incidents.
authors.affiliation: Radiation Oncology, Gustave Roussy, France. Electronic address: renaud.mazeron@gustaveroussy.fr.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Quality and Risk Assessment, Gustave Roussy, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Aguini
authors.affiliation: Radiation Oncology, Gustave Roussy, France.
authors.forename: Eleonor
authors.initials: E
authors.lastname: Rivin
authors.affiliation: Medical Physics, Gustave Roussy, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Baudré
authors.affiliation: Radiation Oncology, Gustave Roussy, France.
authors.forename: Marie-Stéphanie
authors.initials: MS
authors.lastname: Bour
authors.affiliation: Medical Physics, Gustave Roussy, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Radiation Oncology, Gustave Roussy, France.
authors.forename: Frederik
authors.initials: F
authors.lastname: Hubert
authors.affiliation: Medical Physics, Gustave Roussy, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Lopes
authors.affiliation: Ecole Centrale Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Desroches
authors.affiliation: Radiation Oncology, Gustave Roussy, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.affiliation: Medical Physics, Gustave Roussy, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Lefkopoulos
authors.affiliation: Radiation Oncology, Gustave Roussy, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
mesh_terms: D006801:Humans; D061214:Patient Safety / Q000592:standards; D011878:Radiotherapy / Q000592:standards*; D018570:Risk Assessment / Q000379:methods*; D012308:Risk Management / Q000379:methods*; D012449:Safety / Q000592:standards*
keywords: Global Risk Analysis; Mapping; Radiotherapy; Risk assessment; Safety