Prospective approaches for risk analysis in modern radiotherapy : the Italian experience and the contribution of medical physicists

In the last few years there has been significant development of radiation therapy (RT) equipment with advanced imaging and delivery techniques, as well as treatment planning systems. From this perspective, proactive approaches for risk assessment were identified as a powerful tool in modern radiation oncology. A multidisciplinary working group (WG) has been established in the framework of the Italian association for medical physics (AIFM) to promote the use of prospective approaches in the radiotherapy scientific community. This paper describes the main actions carried out by the WG in order to collect information about the engagement of Italian medical physicists in the risk management process, in reporting possible incidents in RT and in the procedures of collecting and analysing near misses. In particular, the main scope of the study was to evaluate the actual level of experience in use of proactive risk analysis tools in modern RT by medical physicists. Finally, the measures implemented by the WG in order to promote the use of such approaches, and consequently to contribute to enhancing safety and radiation protection culture in radiation oncology are described

Approcci prospettici per l'analisi del rischio nella moderna radioterapia : l'esperienza italiana e il contributo dei fisici medici

Nell\u2019ultimo decennio si \ue8 assistito ad un significativo sviluppo nel settore della radioterapia (RT) grazie a nuovi strumenti e modalit\ue0 di imaging, di irraggiamento e di pianificazione dei trattamenti. In quest\u2019ottica, gli approcci prospettici di analisi del rischio, in primis il Failure Mode and Effects Analysis (FMEA), sono stati identificati come validi strumenti per rilevare possibili criticit\ue0 di un processo di moderna RT, per la valutazione dei rischi associati a tali criticit\ue0 e, conseguentemente, per la messa in opera di possibili azioni correttive atte a mitigare il rischio di incidenti e malfunzionamenti. Un gruppo di lavoro multidisciplinare \ue8 stato istituito nel quadro della Associazione Italiana di Fisica Medica (AIFM) per promuovere l'uso degli approcci prospettici di analisi del rischio nella comunit\ue0 scientifica operante nel settore della moderna radioterapia. Vengono qui descritte le principali azioni svolte al fine di raccogliere informazioni sul coinvolgimento dei fisici medici italiani nel processo di gestione del rischio, nel riferire eventuali incidenti in RT, e nelle procedure di raccolta e analisi dei dati relativi ad eventi di near misses. In particolare, lo scopo principale dello studio \ue8 quello di valutare l'effettivo livello di esperienza dei fisici medici nell'uso di strumenti di analisi proattiva dei rischi nella moderna RT. Sono infine descritte le misure attuate dal gruppo di lavoro al fine di promuovere l'uso di tali approcci, e conseguentemente di contribuire a migliorare la sicurezza dei pazienti e la cultura della radioprotezione in RT

Proceedings of the WOrld Congress on Medical Physics and Biomedical Engineering

The citotoxic effect of heating and the enhancemert of the radiotherapy effectiveness combined with hyperthermia has favouredt he development of technology for loco-regional treatments. For a better choose of hyperthermic treatment technique, measurements have been carried out, in order to characterize two differentunits: a couple of capacitive electrodes working at 13.56 MHz (M.M.E.) and a wave guide TEM working at 27 MHz (Aeritalia). The phantoms used were built using compositions suitable to simulate tissues dielectric constant and electric conductivity at the frequencies of interest. Measurements were carried out toi nvestigate the heating omogeneity and the possible existence of disperse fields and hot spots. These two different heating techniques are used in our Institution fo rpelvic tumors treatments

Quality assurance of 3D-CRT : indications and difficulties in their applications

Although more advanced techniques such as intensity-modulated radiotherapy are rapidly spreading, 3D conformal radiotherapy (3D-CRT) remains the standard of treatment for many diseases. The authors outline essential indications to guarantee the quality of 3D-CRT treatments. Criteria for clinical indications and potential clinical advantages and disadvantages of 3D-CRT technology are presented. After briefly listing human and technological resources requirements, procedures for 3D-CRT and physical aspects peculiar to 3D-CRT are described. Medical physics support activities are also considered, including suggestions concerning quality control protocols. Difficulties in the application of correct quality procedures, particularly related to human and technological resources, procedures for patient positioning, imaging, contouring, treatment planning, in vivo dosimetry, set-up verification, follow-up, dose delivery are then discussed