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The Role of Independent Audits in Quality


A Beavis

D Letourneau

S Kry





A Beavis1*, D Letourneau2*, S Kry3*, (1) Queens Centre for Oncology & Haematology, Cottingham, ,(2) Princess Margaret Hospital, Toronto, ON, (3) MD Anderson Cancer Ctr., Houston, TX

TU-A-Salon AB-1 Tuesday 7:30:00 AM - 9:30:00 AM Room: Salon AB

A number of guidance documents are aimed at supporting quality care in radiation therapy. However, much can be learned by evaluating and comparing practice patterns, determining areas of deficiencies, and providing support to programs. In the United Kingdom, an audit program was established as part of a national effort to standardize and improve the quality of care. The program includes site visits by physicists from other centers where measurements are performed along with a review of the program. These visits have led to a variety of improvements nationally. In Ontario, the Cancer Care Ontario program has a similar goal of improving quality throughout the province. The collaborative quality assurance (CQA) program was established to assess the planning and delivery quality of both static-gantry IMRT and arc-based IMRT delivery (e.g. VMAT and TomoTherapy) through a standardized end-to-end test which includes planning exercise and a site visit. 14 centers have participated in the program in the first two years, with tests completed for both prostate and head and neck cancer. In addition to results comparing the planned to measured dose distributions, feedback is provided on the planning practice, phantom set-up, plan delivery, beam model and machine performance. Extension of the CQA funding to 2017 enabled a program designed to assess change in planning and delivery performance through repeat visits. In North America, the quality of irradiation and beam commissioning is evaluated for radiotherapy centers participating in NIH-sponsored clinical trials. These remote dosimetry and phantom programs have supported assuring quality in trials with 1809 and 236 participants throughout North America and elsewhere in the world, respectively. These North American audits have not only improved the accuracy of dose delivery for clinical trial participants, but have also yielded secondary benefits to Radiation Oncology practice and patient safety.

Learning objectives:

1. Learn about a mechanism to improve the quality of care through an audit program in the United Kingdom

2. Understand the value of comparing standard measurements for an advanced technology directly with other programs as done in Ontario, Canada

3. Learn about the mechanisms available in the US to evaluate quality compared to other centers in support of quality in clinical trials and their impact beyond auditing

Acknowledgements: NIH CA10953-45 (RPC), CA081647 (ATC) and Cancer Care Ontario


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