In mid-2017, the Work Group on the Implementation of TG-100 surveyed 418 participants of six TG-100 workshops. We wanted to determine how many of the participants were implementing prospective risk management techniques in their own clinics. For those working on such projects, we asked for details about their chosen area of focus, any benefits seen, and any barriers encountered. We also requested suggestions about how the AAPM can support these activities. The workshops surveyed included the 2013 AAPM Summer School, the 2016 TG100 Certificate Course, and workshops at the North Central AAPM Chapter Meeting (2014), the Southwest AAPM Chapter Meeting (2016), the Penn-Ohio AAPM Chapter Meeting (2016), and the Great Lakes AAPM Chapter Winter Meeting (2016). We would like to thank the 62 respondents who took the time to complete the survey. In this article we present the survey results and the Work Group activities which have followed.

The majority of respondents were from the United States of America (85.7%), with additional responses from South Korea (3.9%), Australia (2.6%), Canada (2.6%), Saudi Arabia (1.3%), Sweden (1.3%), Brazil (1.3%), and Hong Kong (1.3%). Most respondents worked in centers with 2-6 treatment units (including brachytherapy units), though the number of units ranged from 1 to 21.

A good number of respondents (55%) had used the TG-100 workshop tools at their home facility to develop a process map, perform a Failure Mode and Effects Analysis (FMEA), and/or design a quality management program. More than half (55%) of those activities were performed with a multidisciplinary group, with an additional one-third (32%) performed with multiple participants within a single discipline. Interestingly, only a small number of respondents (23%) had carried through to a fault-tree analysis (FTA), perhaps because it was presented as the final step of a long process.

The majority of the analyses were performed on pre-existing procedures (76%), with a substantial minority on the implementation of new procedures (46%). Since participants may have done more than one analysis, multiple answers to this question were allowed. The most common items changed as a result of the prospective risk analyses were the pre-treatment plan review process (62%) and treatment procedures (58%). Post-treatment completion checks were least-likely to be altered (24%).

Respondents saw an improvement in treatment quality (60% agree vs. 5% disagree) and communication among team members (65% agree vs. 7% disagree). Comments speak to improving clinical workflow, standardizing procedures, and fostering open communication. In terms of student and resident, education, the tools of TG-100 were found to be a good framework for studying safety and quality. Respondents also discussed the barriers encountered. The time required to complete the analysis was the greatest barrier, followed by lack of "buy-in" from other team members.

WG-100 has developed a number of strategies to mitigate these challenges, so that those interested in prospective risk management can effectively bring these techniques into their clinics:

• Video-based Implementation Guide – the Implementation Guide summarizes the key points of TG-100, explains available tools, and directs viewers to additional resources in a series of short, focused videos. These videos may be found here. Currently, the videos are only available to AAPM members.
• Professional Session at the 2018 AAPM Annual Meeting – this session will focus on practical details of implementation (persuasion of team members, organization of meetings, tips and tricks to simplify the process) both from a small and large clinic perspective. Please make plans to attend the "Prospective Risk Management in the Wild: Tales from the Clinic" session!
• SAM workshops – Please contact a co-chair of WG-100 (Peter Dunscombe or Saiful Huq) if you are interested in arranging a 4-hr or 8-hr SAM workshop on TG-100 for a local meeting.
• Repository of Risk Management Examples - We are in the process of creating a repository of both completed examples and downloadable forms and workflows in order to reduce the workload on the individual physicist.

We hope these steps can lower the entry barrier to prospective risk management work, bringing its benefits to a wider audience.