title: Patient safety in external beam radiotherapy, results of the ACCIRAD project: Current status of proactive risk assessment, reactive analysis of events, and reporting and learning systems in Europe.
abstract: To describe the current status of implementation of European directives for risk management in radiotherapy and to assess variability in risk management in the following areas: 1) in-country regulatory framework; 2) proactive risk assessment; (3) reactive analysis of events; and (4) reporting and learning systems.
  
  
  
  The original data were collected as part of the ACCIRAD project through two online surveys.
  
  
  
  Risk assessment criteria are closely associated with quality assurance programs. Only 9/32 responding countries (28%) with national regulations reported clear "requirements" for proactive risk assessment and/or reactive risk analysis, with wide variability in assessment methods. Reporting of adverse error events is mandatory in most (70%) but not all surveyed countries.
  
  
  
  Most European countries have taken steps to implement European directives designed to reduce the probability and magnitude of accidents in radiotherapy. Variability between countries is substantial in terms of legal frameworks, tools used to conduct proactive risk assessment and reactive analysis of events, and in the reporting and learning systems utilized. These findings underscore the need for greater harmonisation in common terminology, classification and reporting practices across Europe to improve patient safety and to enable more reliable inter-country comparisons.
authors.affiliation: Department of Electroradiology, University of Medical Sciences, Poznan, Poland; Greater Poland Cancer Centre, Poznan, Poland. Electronic address: julian.malicki@wco.pl.
authors.forename: Julian
authors.initials: J
authors.lastname: Malicki
authors.affiliation: Radiation and Nuclear Safety Authority, Helsinki, Finland.
authors.forename: Ritva
authors.initials: R
authors.lastname: Bly
authors.affiliation: SECTOR, Paris, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Bulot
authors.affiliation: Nuclear Safety Authority - ASN, Paris, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Godet
authors.affiliation: Luxembourg Institute of Science and Technology (LIST), Esch/Alzette, Luxembourg.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jahnen
authors.affiliation: Department of Translational Medicine, University of "Piemonte Orientale", Novara, Italy(1).
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
authors.affiliation: Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France(1).
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.affiliation: Fundación Investigación Biomédica Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Prieto Martin
authors.affiliation: Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Przybylska
authors.affiliation: Department of Electroradiology, University of Medical Sciences, Poznan, Poland; Greater Poland Cancer Centre, Poznan, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Skrobała
authors.affiliation: Nuclear Safety Authority - ASN, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Valero
authors.affiliation: Radiation and Nuclear Safety Authority, Helsinki, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Jarvinen
mesh_terms: D005060:Europe; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D061214:Patient Safety / Q000592:standards*; D017410:Practice Guidelines as Topic; D011832:Radiation Injuries / Q000517:prevention & control*; D011878:Radiotherapy / Q000592:standards*; D018570:Risk Assessment; D012308:Risk Management / Q000379:methods*
keywords: ACCIRAD; Adverse error-event; Events reporting; Near miss; Risk management