[From Crex mutualisation to clinical audit]

In mid-2004, following a Mission nationale d'expertise et d'audits hospitaliers (MeaH) proposal, three voluntary cancer centres started setting up a safety procedure in radiotherapy. Their work made it possible to single out the need to continue elaborating a repository, aiming at a "minimal written reference", to take into account the human factor as one of the four families of factors contributing to a systemic deviation and to build collectively, in radiotherapy departments, the experience feedback committee (comité de retour d'expérience [Crex]). Formalizing a comité de retour d'expérience is unavoidable in any safety-management system (SMM or MGS). The comité de retour d'expérience enables every active member of a department to listen to any of the events of the month (incidents and precursors), to select the event which will be under scrutiny for the next systemic analysis (Orion(©) method) and above all to choose the most appropriate correcting action and ensure its proper implementation. That approach has been approved and then acknowledged by the Autorité de sûreté nucléaire (ASN) before being extended to the other radiotherapy departments. The use of the comité de retour d'expérience, which is a safety management tool, should not be limited to a local circle of insiders, but shared to benefit everybody. Putting comité de retour d'expérience together - a move that was hoped for and brought up as soon as the tool was created - is now being implemented. Several initiatives have already permitted to assess its collective interest; other steps have yet to be taken to enable a true collective sharing of experience. On this basis, the definition of quality/safety practices in radiotherapy will allow the professionals to implement clinical audits in 2012.