[en] In order to give a correct coverage of the target volume and a protection sufficient to sane liver, it is essential to reduce errors. The analysis of the different sources of errors shows that it is still necessary to bring improvements. The protocols of radiotherapy guided by image should definitively optimize this targeted radiotherapy. (N.C.)

[en] Purpose. - The activity of our radiation oncology department mainly relies on breast pathology. Since July 2009, all the irradiations delivered simultaneously to the breast (CTV1), the surgical bed (CTV2), the internal mammary chain and the supra- and infra-clavicular areas have been carried out using a mono-isocentric technique. This study aimed to compare dosimetric results between conventional 2D and mono-isocentric 3D techniques with or without optimization. Patients and methods. - From January to August 2009, 20 patients with breast cancer in whom irradiation of the CTV1, CTV2, internal mammary chain and supra- and infra-clavicular areas was retained, were included in a specific cohort. In each case, we have compared dosimetric results obtained with the conventional technique and with a mono-isocentric 3D technique, either with manual field in the field segmentation or with automatic segmentation (Oncentra Masterplan^R from Nucletron^R, Optimizer^R solution). Selected criteria were as follows: V95, V107 and mean dose (Dmean) to the target volumes, V20 and V30 to the ipsilateral lung, V35 and mean dose to the heart and maximal dose (Dmax) to the spinal cord. Results. - Supra- and infra-clavicular areas irradiation was significantly better using the mono-isocentric 3D technique (V95 %: 89.7 % vs. 77.1 %; P = 0.001) as well as dose homogeneity (Dmean: 46.3 Gy vs. 45.1 Gy; P = 0.008). No statistical difference was observed for the other target volumes. Heart and spinal cord protection were better with the mono-isocentric 3D technique (respectively Dmean: 8.4 Gy vs. 11.1 Gy; P < 0.0001 and Dmax: 29.2 Gy vs. 35.8 Gy; P 0.0003). Conclusion. - Mono-isocentric irradiation of the breast and lymphatic areas is a modern technique that benefits from imaging and computer progresses while being simple to carry out using standard planning system and linear accelerators. Mono-isocentric 3D irradiation with manual segmentation of the breast and the nodal areas provides a target volume irradiation comparing with conventional technique 2D and a better protection of the heart and of the spinal cord. (authors)

[en] Three articles are relative to the quality of treatments, in their tolerance, quality of positioning, and tolerance and response with a combined therapy such radiotherapy and chemotherapy. Dosimetry, protection of organs and the response rate without toxicity are clearly detailed. It concerns liver and colorectal cancers. (N.C.)

[en] Irradiation of operators and patients during coronary angiograms (CA) and percutaneous coronary interventions (PCI) are legitimate matter of concern of modern interventional cardiology. Femoral and right radial approaches are privileged accesses for the CA and PCI. However, few registers compare these 2 accesses in term of operators and patients irradiation. The purpose of this register is to establish a comparative evaluation between these 2 techniques. 423 consecutive patients having benefited in our center either one or the other of these techniques performed between October, 2005 and March, 2006 were included. The retained parameters are: Left operator arm dose, patient surface dose, global procedure time and scopy time. The results are significantly higher in radial CA and PCI ad hoc than in femoral access for the four studied parameters: (1) scopy time: 4 min versus 1.8 min, and 9.6 min versus 6.3 min; (2) procedure time: 15 min versus 9.5, and 41 min versus 35.25 min; (3) patient dose: 59 Gy cm² versus 37.5 Gy cm², and 123 Gy cm² versus 102 Gy cm²; (4) operator dose: 29 μSv versus 13 μSv, and 69 μSv versus 40 μSv. In spite of its interest with less post-operative vascular complications, the right radial access is significantly more irradiating for the operators and the patients than the femoral access. (author)

[en] Purpose To deploy an inductive process for radiotherapy risk management in a regional cancer centre and to infer the actions required to solve the situations of criticality. Methods Close collaboration between the department of radiation oncology-biophysics and the department of quality and risk management in the same institution allowed to create a multi professional and multidisciplinary task force and to make the experience feedback easier. A preliminary risk analysis method was used to identify the generic dangers, the mapping of risks and the specification of the scales of criticality. This method helped to evaluate and to rate each apprehended event. Four scales have been defined: seriousness scale in five levels, likelihood scale in five classes, endeavour scale in four levels and criticality scale in three categories: acceptable (criticality 1) tolerable under control (criticality 2) and unacceptable (criticality 3). Results Fifty-seven level 1 dangerous situations linked to 78 scenarios of criticality acceptable, tolerable and unacceptable in 24, 44 and 10 cases respectively have been identified in the department of radiotherapy leading to carry out 28 risk reduction actions. Conclusions The performed risk analysis offered an original frame for a collective thinking among the care providers and contributed to modify their mode of conceiving both security and radioprotection. The study allowed us to give a relevant answer to the High Authority of Health and the Authority of Nuclear Security demands either in terms of efficient management of the risks in radiotherapy or regarding the daily concerns of the care-givers. (authors)