AI Article Synopsis
- The radiation oncology accident at the Public General Hospital in Epinal is the most severe in France, classified as level 6 on a scale of 10 due to treatment process errors and misuse of dynamic wedges, leading to a 20% overdose in certain patients.
- Between May 2005 and August 2006, prostate cancer patients suffered serious clinical consequences, with adverse effects rated from grade 2 to 5 on the CTCAE scale.
- In response to the incident, treatments were halted for several months to revamp department management focusing on quality and safety, while emphasizing the need for robust quality control measures in the future.
Article Abstract
The accident of radiation oncology at the Public General Hospital in Epinal, Vosges, is the highest in France. It is classified level 6 on a 10 degrees scale of the ASN/SFRO (Autorité de sûreté nucléaire/Société française de radiothérapie oncologique). It is linked to errors in the process of treatment, and a mistake in the use of dynamic wedges, with an overdosage of 20%. The clinical consequences are severe, for the patients treated for a prostate cancer and exposed to this overdosage, between May 2005 and August 2006. Sequelae were classified grade 2 to 5 on the CTCAE 3.0 scale. A second cohort of 397 was identified, which received an overdose of 10% linked to the daily use of portal imaging, which explained a higher risk of gr 2-3 rectitis. The treatments were interrupted in this hospital for several months, to organize a new management of the department, based on quality and safety. The preventive actions to avoid such an accident necessitate to evaluate standard and innovative treatments, to develop an internal and external quality control program.
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| http://dx.doi.org/10.1016/j.canrad.2007.09.004 | DOI Listing |
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