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Strengthening incident learning in radiotherapy practice: insights from the MARLIN study
C Prieto1,2, C Kelly3, G Brusadin4
1Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Medicina, Universidad Complutense de Madrid, Spain.
Clinical and Translational Radiation Oncology
|June 12, 2026
Summary
Incident Learning Systems (ILSs) in radiotherapy show significant variability across Europe. The MARLIN study provides recommendations for harmonized, risk-informed ILS implementation to enhance patient safety and regulatory compliance.
Area of Science:
- Medical Physics
- Radiotherapy Safety
- Health Systems Research
Background:
- Incident Learning Systems (ILSs) are crucial for patient safety in radiotherapy, aiming to learn from adverse events and near misses.
- Despite EU regulations, significant inconsistencies exist in ILS implementation and effectiveness across European radiotherapy facilities.
- The MARLIN study addresses this variability by proposing radiotherapy-specific recommendations for harmonized ILS implementation.
Purpose of the Study:
- To identify current practices, barriers, and enabling factors for ILS implementation in European radiotherapy.
- To develop evidence-based, radiotherapy-specific recommendations for improving ILS implementation.
- To support harmonized, risk-informed application of ILSs in radiotherapy across Europe.
Main Methods:
- A 24-month study (MARLIN) utilizing a structured literature review.
- An online European survey of 172 respondents from 28 countries, including clinical facilities, competent authorities, and professional societies.
- Expert interviews and a multi-stakeholder consensus workshop to gather comprehensive data.
Main Results:
- Transposition of the EU Directive was reported, but significant variability in event reporting criteria, feedback, and database use was observed.
- Key barriers included fear of punitive actions, limited resources, inadequate training in incident analysis, and poor dissemination of lessons learned.
- External-beam radiotherapy demonstrated more mature ILS implementation compared to brachytherapy.
Conclusions:
- The MARLIN recommendations offer a practical framework to enhance ILS implementation in radiotherapy.
- These recommendations aim to foster a just culture, improve learning from incidents, and ensure regulatory compliance.
- The study ultimately seeks to improve patient safety and quality of care in European radiotherapy, with broader implications for radiation safety in other medical fields.
