Desenvolvimento de modelos de análise da qualidade e do risco aplicáveis à radioterapia

Abstract

Quality in medical and hospital environment is a task of different components: high professional level, optimized use of resources, minimum quantity of risks, as well as high level of patient satisfaction and a considerable final positive impact in health. In the radiotherapy process, it is essential to guarantee the quality of all the activities that ensure consistency between clinical prescription and administration to the patient, the prescribed dose in the target volume, minimum dose in the healthy tissue, minimum exposure of the occupationally exposed personnel, treatment verification that determine the patient outcome and minimize the risks associated with the use of ionizing radiation. Worldwide, during the past 25 years, the growth in radiological incidents or accidents in the radiotherapy area have been documented, most of which are caused by events associated with human failures and not by failures associated with equipment, occurred more frequently in centers classified as high technology institutions. This study is justified considering that, in Brazil, there are 238 Radiotherapy Centers. The aim of this study was to develop two models for quality and risk assessment in Radiotherapy Services: one model for quality analysis using an Index (IQ) based on previously established quality criteria and a second model for the risk analysis of the linear accelerator teletherapy process, using the risk matrix method proposed by the International Atomic Energy Agency (IAEA) and using a Risk Index (IR), which considers the frequency of initializing events, their consequences and the probability of failure of the security barriers involved. This model allows a regressive risk analysis, facilitating the identification of the safety barriers not implemented in the Radiotherapy Service and which ones have a considerable impact on the total risk. The models were tested using the information obtained through data collection in ten Radiotherapy Services located in Rio de Janeiro and Manaus, through interviews and filling out a form developed based on the auditing system of the International Atomic Energy Agency (IAEA) and the mapping of the linear accelerator teletherapy process. From the values of the Quality and Risk Indexes, it was possible to classify the level of quality and risk for each Radiotherapy Service. In conclusion, the results of this study indicate that the proposed models for assessing quality and risk were sensitive enough to identify the areas that need improvement and the safety barriers that should be implemented to decrease the risk. When comparing quality and risk results, it was possible to correlate low-quality indexes with high-risk indexes.