S1502
Interdisciplinary - Quality assurance and risk management
ESTRO 2026
S, Mula-Hussain L, ElHaddad M, et al. Peer Review in RO: Where Does the Middle East, North Africa, and Türkiye Region Stand? JCO Glob Oncol. 2024.4. Talcott W, Covington E, Bazan J. et al. The Future of Safety and Quality in RO. Semin Radiat Oncol. 2024.5. Sidhu MS, Gokhroo G, Mulinti S, et al, Pilot study of RO peer review in LMIC through cloud-based platform. J Cancer Res Ther. 2024. Keywords: peer review, radiation oncology, quality assurance Digital Poster 405 Non-Conformities and Concessions in Radiotherapy: Insights from a Five-Year Incident Learning System Review Susan Traynor 1 , Isabelle Dunne 2 , Colin Kelly 3 , Naomi Lavan 1 , Maeve Kearney 2 1 Radiotherapy Department, St Luke's Radiation Oncology Network, Dublin, Ireland. 2 Applied Radiation therapy Trinity, Disicpline of Radiation Therapy, Trinity College Dublin, Dublin, Ireland. 3 Physics Department, St Luke's Radiation Oncology Network, Dublin, Ireland Purpose/Objective: Incident Learning Systems (ILS) are a cornerstone of risk management and continuous improvement within radiation therapy (RT) departments. In Ireland, the Health Information and Quality Authority (HIQA), as the competent authority under S.I. No. 256 of 2018 for medical exposures to ionising radiation, promotes the reporting and analysis of incidents and near misses to support proactive safety learning. Within quality management frameworks applied to RT, additional categories such as non-conformities—deviations from established protocols or standard operating procedures—and concessions—authorised departures from the intended plan or process—offer further insight into system performance. This study reviewed the number and nature of non-conformities and concessions reported to an ILS in a large Irish RT department over a five-year period, and explored their contribution to strengthening a positive safety culture Material/Methods: All reports submitted to the departmental ILS between 2020 and 2024 were anonymised prior to analysis. Non-conformities and concessions were categorised according to the stage of the patient pathway at which they occurred. Annual rates were calculated relative to the number of treatment fractions delivered. Descriptive statistics were used to identify trends and dominant categories over time. Results: The overall rate of non-conformities and concessions remained stable across the five-year period (Fig 1) and were predominantly categorised as treatment-related.
The predominant type of non-conformity was associated with on-treatment checks (increase rate in 2024 attributed to staffing issues), while concessions most involved imaging, image-guided radiotherapy (IGRT) adjustments, and treatment delivery (Fig 2). The consistent reporting rate suggests both a positive culture of reporting and a balanced level of clinical autonomy in decision-making. However, chart checks are an important safety barrier and the recurring pattern of failure to meet on-treatment checks highlights the need to review SOPs in this area. Similarly, the frequency of concessions between patient set up and beam on — the final stage of the treatment process—suggests that some steps could be strengthened earlier in the workflow through procedural updates promoting more effective upstream risk management.
Conclusion: Non-conformities and concessions represent valuable indicators of latent system vulnerabilities and should be viewed as opportunities for proactive risk management. While on-treatment checks and IGRT remain critical safety barriers, greater focus on upstream processes is essential to further enhance patient safety and reinforce a culture of continuous improvement in RT departments. References: European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018 (S.I. No. 256/2018).Pawlicki T, Coffey M, Milosevic M. Incident Learning Systems for Radiation Oncology: Development and Value at the Local, National and International Level. Clinical Oncology 2017; 29(9):562- 567. DOI:10.1016/j.clon.2017.07.009Kundu P, Jung OS, Valle LF, Edmondson AC, Agazaryan N, Hegde J, Steinberg M, Raldow A. Missing the Near Miss: Recognizing Valuable Learning Opportunities in
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