Quality Control of Radiation Delivery for Lower Gastrointestinal Cancers

Quality control study of cervical cancer interstitial brachytherapy treatment plans using statistical process control

OBJECTIVE

This study explored using statistical process control for quality control of cervical cancer interstitial brachytherapy treatment plans.

MATERIALS AND METHODS

For retrospective analysis, interstitial brachytherapy treatment plans were divided into first (n = 300) and second phases (n = 200). The first phase was chronologically divided 2:1 into training and validation sets. The Dn2cm3 (D2cm3 divided by the high-risk clinical target volume D90) of the organs at risk (the bladder, rectum, and sigmoid colon) were analyzed to draw individual control charts. Process capability analysis charts were drawn, and the statistical process capability was evaluated using the process capability index Cpk. The centerline of the organ at risk dose in the first-phase plan's training set was used as the optimization parameter for the second-phase dataset plan.

RESULTS

The Dn2cm3 centerlines for the bladder, rectum, and sigmoid colon were 0.6980, 0.5440, and 0.4910 in the training set and 0.6845, 0.4528, and 0.4144 in the second phase, respectively. The first-phase δ values were 0.0099, 0.0530, and 0.0268, respectively. The process capability analysis for the first and second phases showed that all indicators had a Cpk >1.

CONCLUSION

For all organs at risk, the Dn2cm3 centerlines were lower in the second phase than in the first phase, indicating that quality control of cervical cancer interstitial brachytherapy treatment plans continuously improved through statistical process control. This method is simple and practical and warrants promotion for application in radiotherapy treatment plan quality control.

Consensus Quality Measures and Dose Constraints for Rectal Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology (ASTRO) Expert Panel

PURPOSE

Ensuring high quality, evidence-based radiation therapy for patients with cancer is of the upmost importance. To address this need, the Veterans Affairs (VA) Radiation Oncology Program partnered with the American Society for Radiation Oncology and established the VA Radiation Oncology Quality Surveillance program. As part of this ongoing effort to provide the highest quality of care for patients with rectal cancer, a blue-ribbon panel comprised of rectal cancer experts was formed to develop clinical quality measures.

METHODS AND MATERIALS

The Rectal Cancer Blue Ribbon panel developed quality, surveillance, and aspirational measures for (a) initial consultation and workup, (b) simulation, treatment planning, and treatment, and (c) follow-up. Twenty-two rectal cancer specific measures were developed (19 quality, 1 aspirational, and 2 surveillance). In addition, dose-volume histogram constraints for conventional and hypofractionated radiation therapy were created.

CONCLUSIONS

The quality measures and dose-volume histogram for rectal cancer serves as a guideline to assess the quality of care for patients with rectal cancer receiving radiation therapy. These quality measures will be used for quality surveillance for veterans receiving care both inside and outside the VA system to improve the quality of care for these patients.

Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Quality Measures Initiative

INTRODUCTION

Ensuring high quality, evidence-based radiation therapy for patients is of the upmost importance. As a part of the largest integrated health system in America, the Department of Veterans Affairs National Radiation Oncology Program (VA-NROP) established a quality surveillance initiative to address the challenge and necessity of providing the highest quality of care for veterans treated for cancer.

METHODS

As part of this initiative, the VA-NROP contracted with the American Society for Radiation Oncology (ASTRO) to commission five Blue-Ribbon Panels for lung, prostate, rectal, breast, and head & neck cancers experts. This group worked collaboratively with the VA-NROP to develop consensus quality measures. In addition to the site-specific measures, an additional Blue-Ribbon Panel comprised of the chairs and other members of the disease sites was formed to create 18 harmonized quality measures for all five sites (13 quality, 4 surveillance, and 1 aspirational).

CONCLUSION

The VA-NROP and ASTRO collaboration have created quality measures spanning five disease sites to help improve patient outcomes. These will be used for the ongoing quality surveillance of veterans receiving radiation therapy through the VA and its community partners.

ETHICS BOARD APPROVAL

N/A - No human subjects were required.

VA-Radiation Oncology Quality Surveillance Program

PURPOSE

We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year.

METHODS AND MATERIALS

State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy.

RESULTS

Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined.

CONCLUSIONS

The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.