No abstract

Risk assessment deals with processes, accident-initiating events, barriers and risk ratings to unveil the fragility and weakness of some processes; within this study, specifically related to radiation therapy facilities. Barriers are technical or organizational safety measures put in place to avoid, prevent, detect, control, reduce or mitigate the consequences of an accident once an initiating event has occurred. In this work, radiological risk analysis was performed for a set of 20 Brazilian radiotherapy facilities making use of the freeware sevrra risk-management software. The objective of this study was to define parameters that could be useful in creating an overall risk profile. This profile would be helpful for establishing priorities for decision making and support a risk-informed regulatory process. The most relevant missing barriers in facilities were identified according to three parameters: the 'importance index', 'impacted facilities index' and the 'barrier-effectiveness index'. Barriers such as 'in vivo dosimetry in the first treatment session', 'weekly in vivo dosimetry to detect errors in the dose delivering process', 'annual external audit for the control of reference dose rate' and 'independent verification of calibration by various medical physicists with a different dosimetry equipment' were found to be the most effective in reducing the risk level of the facilities. The present investigation reinforces the need to strengthen the mechanisms that guarantee the effectiveness of such barriers in radiation therapy procedures.

Radiation therapy is a complex treatment modality involving several technological and professional resources as well as a large number of attributions of these professionals with a high degree of interdependence. Thus there are many possibilities of failure in the treatment process that may lead to an accidental exposure. So regulatory agencies have established guidelines in their regulations in order to prevent accidental exposures through security analysis planning and risk management. The System of EValuation of Risk in RAdiotherapy, also known as SEVRRA, is based on the risk matrix methodology and allows the risk assessment of radiation therapy facilities in a prescriptive way, highlighting events leading to high-risk levels and severe consequences for individuals. With SEVRRA it is also possible to establish an importance analysis of the barriers proposed to avoid or mitigate such events.This work aimed to demonstrate the application of SEVRRA for the risk management of radiation therapy facilities. The risk profile of the facility was determined by identifying the highest risk level events, and the barriers of greater impact for the overall risk level. After implementing some missing barriers in the original facility profile, it was achieved a reduction from 31% to 8% in the number of events leading to high-risk level, showing the effectiveness of SEVRRA for the risk management in radiation therapy facilities.

The Brazilian Nuclear Energy Commission (cnen) has been making a constant effort to keep up to date with international standards and national needs to strengthen the status of radiological protection of the country. The guidelines related to radiation therapy facilities have been revised in the last five years in order to take into consideration the most relevant aspects of the growing technology as well as to mitigate the accidents or incidents observed in practice. Hence, clinical dosimeters have gained special importance in this matter. In the present work, we discuss the effectiveness of regulation and inspections to the enforcement of instrument calibration accuracy for the improvement of patient dosimetry and quality control. As a result, we observed that the number of calibrated instruments, mainly well chambers, is increasing each year. The same behavior is observed for instruments employed in technologically advanced radiation treatments such as intensity modulated radiotherapy, volumetric therapy and stereotatic radiosurgery. We ascribe this behavior to the new regulation.