Quality Management In Radiation Therapy

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In the field of radiation therapy there are many complex variables and personal that contribute to the treatment of patients. A comprehensive understanding of many personal cooperate to ensure the accuracy and overall safety of treatments. These professionals include medical physicists, dosimetrists, physicians and therapists. In the process of treatments, quality control and assurance are key to prevent errors in the delivery process of treatment. This is nevermore prevalent than with the recent advancements in SRS and SBRT treatments, where treatment margins are generally smaller than conventional treatments and the doses are higher. Moreover, the implementation of quality assurance and quality control, through quality management programs, greatly assists in the development of procedures that can insure proper equipment maintenance and ensure that the patient receives the prescribed dose as safe as possible. Furthermore, radiation oncology professionals can maintain keep up with the advancements in technology by revisiting prior task groups regulated by the American Association of Physicists in Medicine and creating trials with situations the professional may deem in need of review. Facilities can further their quality control and assessment through incidence learning and peer-peer reviews to learn what they can do as an organization to improve their patient care.

As technology advances and quality assurance programs emerge throughout various clinics, theses programs often need to be amended to account for discrepancies that may arise. When this occurs, radiation oncologic professionals can create trials and reports for what they believe needs to be revisited or revised. For example, medical physicists from the Wisconsin Institutes for Medical Research, M. Kissick and T. Mackie, investigate the relationship between dynamic IMRT MLC movement and organ motion as it applies to respiratory motion during the radiation process. They refer to this difference as interference. In their report they discuss how there can be a blurring effect, or inconsistency, on the dose distribution of tomotherapy units based on the motion of the organ, or patient, to the motion of the MLCs. They also reported that this motion blur can cause irregularities in the doses received by the patient. They suggest an update to a TG-76 report to “include a criterion for the use of motion management techniques with dynamic IMRT that better includes the effects of frequency similarity and difference between MLC leaves and other modulation motions and tumor motion.” (M. Kissick, 2009)Their suggestion on how this could be applied in a clinical setting includes a way to provide a QA process with checks for the motion of each type of device used for motion monitoring and each patient’s motion. They explain that this can significantly reduce the blur between the motion variables of the MLCs and the patient. Furthermore, they suggested that the motion frequencies of both the patient and the treatment unit have separate values for the treatment plan. Lastly, they believe, that while this was done on a tomotherapy unit, they believe that this applies to all LINACs treating respiratory plans and using dynamic IMRT.

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When a facility doesn’t have a QA program or is having problems with quality assurance and control an incident learning plan can help the facility learn from their mistake and ensure better patient care for the future. One such incident is illustrated by a research article published from Peking University Third Hospital, Beijing, China entitled, “Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy.” In this article, the authors peer-review several published reports to establish the effectiveness of a facility using an incident learning plan. In one example, the authors report that data was collected over a two-year period with external beam radiation therapy where the first year was without an incidence learning plan and the second was with the plan. There was a total of 28 near misses and 5 incidences reported out of 1262 patients treated between the 2-year period. There were 6 near misses where the contouring and treatment planning was done on the incorrect side laterally, 7 cases of near misses from incorrect dose prescriptions, 5 cases of incorrect treatment dose being administered due to calculation and calibration errors, 7 cases due to wrong location, 7 cases from nonoptimal planning, and 1 from an incorrect patient being treated due to having the same last name. According to their calculations, the average incidence rate dropped from 0.56% to 0.28% and the near miss rate dropped from 2.22% to 1.24%. (Ruijie Yang, 2014) In conclusion, the authors explain that their results demonstrate that implementing an incident learning system can lower the rates of incidence and improve patient safety in even the most technologically advanced facilities.

A growing trend is on the rise in radiation oncology. An article by The University of Texas MD Anderson Cancer Center explains how integrated comprehensive peer-reviews can improve overall quality and safety of patient treatments. The authors used four cities and 719 patient cases for this study. They split the patient cases into two groups, peer-reviewed cases and quality audits. With the quality audited patient cases 78% were within compliance of national guideline standards and 22% were outside compliance. In comparison, only 17% of the peer-reviewed patient cases were noncompliant. They found that there was the correlation of quality audits that were noncompliant were under inappropriate plans from management, radiation management and technical aspects of planning. (The University of Texas MD Anderson Cancer Center, 2014) In conclusion, the authors deduced that a peer-review audit program can help to improve patient outcomes and lower costs ensuring a high quality and value of care for patients. They also recommend low and high-volume facilities to partner and create enhanced peer-to-peer relationships.

In conclusion, there are a variety of ways that facilities can improve their quality control and assessment. One example they can do this is through clinical trials to review prior task group procedures and make recommendations on how to improve an individual regulation. The physicists from Wisconsin Institutes for Medical Research did this through reviewing a regulation dictated by task group 76 and offering recommendations on further upgrades to the task group through the results of their clinical trial. Another example is when a department in radiation oncology from Beijing examined how introducing incidence learning plans can help a program find areas of improvement and lower incidence rates and near misses by learning from past incidence. The last example is from The University of Texas MD Anderson Cancer, where patient cases were split into 2 groups, quality audits and peer-peer reviews. The reviewed cases resulted in showing that peer-peer reviews were better at detecting noncompliance of regulation standards then quality audits by themselves. Overall, there are many ways to improve quality control and assessment through quality management programs and individuals conducting clinic trials and case reviews. Going forwards in the field of radiation oncology, it is important to remember that you should always strive to create the safest atmosphere for the patients and continue to make advances in quality management to ensure patient safety and precise effective treatments. 


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