Keywords: Multidisciplinary approach; radiation therapy; quality assurance
Quality Assurance in Radiation Therapy:
1. machines
In a modern radiation oncology facility, a quality improvement
committee (QIC) is represented by all sections
of the department. Sources of error in radiation
therapy include tumor localization, lack or inappropriate
patient immobilization, field placement and human
errors in calibration, calculation in daily patient setup,
and equipment-related problems. Many of these equipment
and calculation errors can be minimized through a
quality program comprising periodic checks.
A comprehensive quality assurance program in radiation
therapy has both clinical and physical components.
The production of radiation and the mechanical
motions is controlled by numerous electrical control
circuits. Quality assurance checks are necessary to
verify the functionality of various backup systems to
the primary control system. One of the most important
backup systems available on all the therapy machines is
the emergency system.
To ensure quality in healthcare sector, a radiation
therapy unit should adhere to the following checklist:
• morning conference
These are some of the procedures that are recommended
to assure that the radiation treatments are appropriately
prescribed and accurately delivered.
• Morning conference: It is advisable to develop a
peer review culture in the department. Every morning,
physicians should convene for a peer review of
the treatment plans. It will be desirable to meet in
the form of a team and discuss patients seen and
planned during the previous days. Physicians present
the cases and the colleagues conduct a peer review
of the cases.
• Chart rounds: The staff must meet every week to
review the portal films and clinical condition of patients
under treatment.
• Plan checks: A physicist must check the accuracy of
the calculations and the details of the setup instructions.
• Chart checks: A physicist along with other physicists
and radiation therapy technologists must
weekly review the chart of every patient under
treatment for continuous argument with the treatment
plan.[
• Treatment-machine checks: Each morning, the
radiation output from the linear accelerators must
be measured and checked for consistency. The
physicist must use additional equipment at weekly,
monthly, and annual intervals to maintain the calibrations.
• Patient dose measurement: The radiation dose applied
to selected patients must be measured to verify
the calculations.
• Portal films: Before the treatment begins and at
least weekly thereafter, films are obtained using
treatment beams to verify the continual accuracy
of the dose delivered. Radiation treatment delivery
software must check the output of each beam
of radiation treatment delivery, and therapists must
check all settings against the original plan.[
Measuring the Quality:
• frequently occurring;
Clinical and physical quality indicator data should
be aggregated over time to show trends and patterns.
The selection of indicators is an agenda item of the QIC.
It is important to remember that indicators do not provide
definitive answers about the quality rather prompt
us to question the occurrence of particular events.
Quality assurance and quality control are essential
components of the work performed by the medical physics team. This team provides support to the department
of radiation oncology by providing
• quality control of radiation therapy treatment units,
• Thermoluminescent dosimeter (TLD) monitoring
for clinical and research activities.
Management of Quality Assurance:
• maintaining a coordinated system while approaching
toward improving patient care and health outcomes,
A comprehensive quality assurance system is required
to guarantee the patients that these medical procedures
will yield valuable information or provide needed
treatment that can be appropriately implemented and
used to achieve a positive impact on their health.[
2. methodology
3. manpower
• chart rounds
• plan checks
• treatment-machine check
• patient dose measurements
• beam profiles
An important aspect of quality assurance is a clinical
quality indicator (CQI). A quality indicator is a
measure of an important aspect of the quality of care
or the quality of services provided. It is not a direct
measure of quality but acts as a screening tool or reference
point for monitoring, maintaining, and evaluating
and improving care. Both CQIs and non-CQIs
are used and include those that relate to the structure
function, process, and outcome. In general, indicators
should represent those procedures, conditions, or services
that are
• easy to monitor through the collection of readily
accessible data;
• high risk, high volume, high cost, or problem
prone;
• amenable to intervention; and
• highly variable in the way they are managed.[
• technical support and quality control for brachytherapy,
and
The role of the QIC in managing all aspects of departmental
quality assurance is crucial. Irrespective of the
name, this board bears the ultimate responsibility for
the quality of patient care rendered within the facility.
The key responsibilities of QIC in quality area include
the follow
• understanding the board"s role in the performance
of the improvement program,
• approval of written performance improvement or
quality assessment plan,
• regularly reviewing the results of performance improving
activities,
• explaining the hospitals" performance improvement
program and how quality in patient care is
achieved, and
• familiarity with external audit systems, such as
JCIA and ISO.
The key component is a multidisciplinary approach, which involves a radiation oncologist, a medical physicist, and radiation therapy technologists. This team ensures the quality assurance that involves the 3 Ms.
Peer-review: Externally peer-reviewed.
Conflict of Interest: None declared.
Authorship contributions: Concept - A.N.A.; Supervision - A.N.A.; Data collection &/or processing - Not applicable; Literature search - A.N.A., M.u., B.M.Q.; Critical review - A.N.A., M.u., B.M.Q.
