To analyse the displacement of surgical clips in prone (Pr) position and assess the consequences on target volumes and integral dose of partial breast irradiation (PBI). 30 post-lumpectomy breast cancer patients underwent CT imaging in supine (Su) and Pr. Clip displacements were measured by the distances from the clips to a common fix bony reference point. On each dataset, the tumour bed (TB = clips ± seroma), clinical target volume (CTV = TB + 1.5 cm) and planning target volumes (PTV = CTV + 1 cm) for PBI were determined and the volume pairs were compared. Furthermore estimation of integral dose ratio (IDR) within the breast from tangential treatment was performed as the ratio of the irradiated breast volume and the volume encompassing all clips. Clips close to the chest wall (CW) in Su showed significantly less displacement in Pr. The mean volumes of seroma, CTV and PTV were significantly higher in Pr than in Su. The PTV volume difference (Pr-Su) was significantly higher in patients with presence of seroma, deep clips and TB location in the superior-internal-quadrant (SIQ) and at the junction of superior quadrants (jSQ). In a multivariate analysis two factors remained significant: seroma and TB localization in SIQ-jSQ. The IDR was significantly larger in Su than in Pr (7.6 vs. 4.1 p < 0.01). Clip displacements varied considerably with respect to their relative position to the CW. In selected patients Pr position potentially leads to a significant increase in target volumes of PBI. Tangential beam arrangement for PBI should be avoided, not only in Su but in Pr as well in case of clip-based target volume definition.

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Background The patient’s needs and expectations can be assessed through satisfaction surveys, adverse event declarations and records of complaints. However, by crossing individual complaints, satisfaction surveys in combination with adverse events received we could get valuable information. The objective is to identify common elements of work between these different sources to improve care. Methods A retrospective analysis of patient’s complaints, surveys and adverse events was carried out in order to highlight common improvement items between these 3 sources of information. Results A satisfaction survey was given to the patients at the end of their treatment, who filled it out and left it in the “ad hoc” letterbox. At the end of December 2019, 4695 questionnaires had been collected (response rate 37%). In addition, since 2014, 1369 patients (approximately 20 patients per month) have been interviewed “face to face” by the research nurse who assesses their satisfaction using open questions. At the same time, a collection of complaints and adverse events was carried out. All this data has been analysed and cross-checked in order to highlight areas for improvement, in order to strengthen the safety and quality of care in our department. Conclusions Collecting and analysing satisfactions surveys, unexpected events and complaints constitute in our opinion, an effective tool to achieve patient empowerment. We aim for the patients to become a real player in their safety, involved in the overall effort to improve quality of their radiotherapy treatment by reporting what does not meet their expectations.