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Claridge Mackonis ER, Hardcastle N, Haworth A. A survey of compliance with stereotactic ablative body radiotherapy quality recommendations. J Med Imaging Radiat Oncol 2023. [PMID: 36996443 DOI: 10.1111/1754-9485.13526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/05/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Many publications have proposed quality standards for stereotactic ablative body radiotherapy (SABR). However, data on the level of compliance with these guidelines is lacking in the literature. This study aimed to understand how these guidelines are applied in the clinic and to identify barriers to implementing such recommendations. METHODS Interviews were conducted with multidisciplinary staff at radiation oncology centres across New South Wales formulated around the RANZCR Guidelines for Safe Practice of Stereotactic Body (Ablative) Radiation Therapy. The interview responses were grouped into 20 topics, assessed against the guidelines and thematically analysed. RESULTS Good compliance with the guidelines was found, with more than 80% of centres achieving satisfactory results in more than half the topics. The areas with the lowest compliance were auditing, risk assessment and reporting recommendations. Barriers to the quality of SABR treatments included limited training opportunities, low patient numbers and a lack of clear requirements on comprehensive auditing and reporting. CONCLUSION Overall, the centres surveyed reported good compliance with most of the RANZCR SABR guidelines. The tasks with the lowest compliance were those that monitor quality outcomes. Potential strategies for improvement include inclusion in clinical trials and the use of databases which link treatment parameters, dosimetry and outcomes. Further work will focus on the barriers identified in this survey and propose practical solutions to improve compliance in these areas.
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Affiliation(s)
- Elizabeth Ruth Claridge Mackonis
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Nick Hardcastle
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
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Hong DS, Boike T, Dawes S, Klash SJ, Kudner R, Okoye C, Rosu-Bubulac M, Watanabe Y, Wright JL, Jennelle RL. Accreditation Program for Excellence (APEx): A Catalyst for Quality Improvement. Pract Radiat Oncol 2020; 11:101-107. [PMID: 33279669 DOI: 10.1016/j.prro.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE In 2014 the American Society for Radiation Oncology's Accreditation Program for Excellence (APEx) was created in response to the Target Safely campaign. APEx is a powerful tool to measure and drive quality improvement in radiation oncology practices. METHODS AND MATERIALS A task group from the American Society for Radiation Oncology's Practice Accreditation Committee was formed to provide an overview of the APEx accreditation program including analysis from specific program data. RESULTS Through initiatives encouraged by the APEx program, participants are able to evaluate teamwork and effectiveness, implement documented procedures aimed at improving quality and safety, and establish quality management at the practice. The program's Self-Assessment measures performance with program requirements and indicates where compliance lacks standardization. Methods to address these deficiencies form part of on-going quality improvement. These quality outcomes promote the delivery of safe, high-quality care. CONCLUSION The accreditation process through APEx is a commitment to an ongoing safety culture. Any worthwhile accreditation program should provide a meaningful assessment of practice operations, supply the tools to identify deficiencies and provide the opportunity to showcase growth and development. A commitment to completing APEx is a commitment to excellence for patients and all those who care for them.
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Affiliation(s)
- David S Hong
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
| | | | - Samantha Dawes
- American Society for Radiation Oncology, Arlington, Virginia.
| | | | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | | | - Mihaela Rosu-Bubulac
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, Virginia
| | - Yoichi Watanabe
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | | | - Richard L Jennelle
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
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Ford E, Conroy L, Dong L, de Los Santos LF, Greener A, Gwe-Ya Kim G, Johnson J, Johnson P, Mechalakos JG, Napolitano B, Parker S, Schofield D, Smith K, Yorke E, Wells M. Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275. Med Phys 2020; 47:e236-e272. [PMID: 31967655 DOI: 10.1002/mp.14030] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND While the review of radiotherapy treatment plans and charts by a medical physicist is a key component of safe, high-quality care, very few specific recommendations currently exist for this task. AIMS The goal of TG-275 is to provide practical, evidence-based recommendations on physics plan and chart review for radiation therapy. While this report is aimed mainly at medical physicists, others may benefit including dosimetrists, radiation therapists, physicians and other professionals interested in quality management. METHODS The scope of the report includes photon/electron external beam radiotherapy (EBRT), proton radiotherapy, as well as high-dose rate (HDR) brachytherapy for gynecological applications (currently the highest volume brachytherapy service in most practices). The following review time points are considered: initial review prior to treatment, weekly review, and end-of-treatment review. The Task Group takes a risk-informed approach to developing recommendations. A failure mode and effects analysis was performed to determine the highest-risk aspects of each process. In the case of photon/electron EBRT, a survey of all American Association of Physicists in Medicine (AAPM) members was also conducted to determine current practices. A draft of this report was provided to the full AAPM membership for comment through a 3-week open-comment period, and the report was revised in response to these comments. RESULTS The highest-risk failure modes included 112 failure modes in photon/electron EBRT initial review, 55 in weekly and end-of-treatment review, 24 for initial review specific to proton therapy, and 48 in HDR brachytherapy. A 103-question survey on current practices was released to all AAPM members who self-reported as working in the radiation oncology field. The response rate was 33%. The survey data and risk data were used to inform recommendations. DISCUSSION Tables of recommended checks are presented and recommendations for best practice are discussed. Suggestions to software vendors are also provided. CONCLUSIONS TG-275 provides specific recommendations for physics plan and chart review which should enhance the safety and quality of care for patients receiving radiation treatments.
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Affiliation(s)
- Eric Ford
- University of Washington Medical Center, Seattle, WA, USA
| | - Leigh Conroy
- The Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lei Dong
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | - Koren Smith
- Mary Bird Perkin Cancer Center, Baton Rouge, LA, USA
| | - Ellen Yorke
- Memorial Sloan-Kettering Cancer Center, Manhattan, NY, USA
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Kapoor R, Moghanaki D, Rexrode S, Monzon B, Ray M, Hulick PR, Albuquerque K, Rosenthal SA, Palta JR, Hagan MP. Quality Improvements of Veterans Health Administration Radiation Oncology Services Through Partnership for Accreditation With the ACR. J Am Coll Radiol 2018; 15:1732-1737. [DOI: 10.1016/j.jacr.2018.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Gopan O, Smith WP, Chvetsov A, Hendrickson K, Kalet A, Kim M, Nyflot M, Phillips M, Young L, Novak A, Zeng J, Ford E. Utilizing simulated errors in radiotherapy plans to quantify the effectiveness of the physics plan review. Med Phys 2018; 45:5359-5365. [DOI: 10.1002/mp.13242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Olga Gopan
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Wade P. Smith
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Alexei Chvetsov
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Kristi Hendrickson
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Alan Kalet
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Minsun Kim
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Matthew Nyflot
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Mark Phillips
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Lori Young
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Avrey Novak
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Jing Zeng
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
| | - Eric Ford
- Department of Radiation Oncology University of Washington Medical Center 1959 NE Pacific Street, Box 356043 Seattle Washington 98195 USA
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Ford EC, Nyflot M, Spraker MB, Kane G, Hendrickson KRG. A patient safety education program in a medical physics residency. J Appl Clin Med Phys 2017; 18:268-274. [PMID: 28895282 PMCID: PMC5689904 DOI: 10.1002/acm2.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 03/29/2017] [Accepted: 05/23/2017] [Indexed: 11/11/2022] Open
Abstract
Education in patient safety and quality of care is a requirement for radiation oncology residency programs according to accrediting agencies. However, recent surveys indicate that most programs lack a formal program to support this learning. The aim of this report was to address this gap and share experiences with a structured educational program on quality and safety designed specifically for medical physics therapy residencies. Five key topic areas were identified, drawn from published recommendations on safety and quality. A didactic component was developed, which includes an extensive reading list supported by a series of lectures. This was coupled with practice-based learning which includes one project, for example, failure modes and effect analysis exercise, and also continued participation in the departmental incident learning system including a root-cause analysis exercise. Performance was evaluated through quizzes, presentations, and reports. Over the period of 2014-2016, five medical physics residents successfully completed the program. Evaluations indicated that the residents had a positive experience. In addition to educating physics residents this program may be adapted for medical physics graduate programs or certificate programs, radiation oncology residencies, or as a self-directed educational project for practicing physicists. Future directions might include a system that coordinates between medical training centers such as a resident exchange program.
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Affiliation(s)
- Eric C. Ford
- Department of Radiation OncologyUniversity of WashingtonSeattleWA98195USA
| | - Matthew Nyflot
- Department of Radiation OncologyUniversity of WashingtonSeattleWA98195USA
| | - Matthew B. Spraker
- Department of Radiation OncologyUniversity of WashingtonSeattleWA98195USA
| | - Gabrielle Kane
- Department of Radiation OncologyUniversity of WashingtonSeattleWA98195USA
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Izewska J, Coffey M, Scalliet P, Zubizarreta E, Santos T, Vouldis I, Dunscombe P. Improving the quality of radiation oncology: 10years' experience of QUATRO audits in the IAEA Europe Region. Radiother Oncol 2017; 126:183-190. [PMID: 28988660 DOI: 10.1016/j.radonc.2017.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. MATERIALS AND METHODS The 31 QUATRO reports collected over 10years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations). RESULTS Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation protection were frequently commended by QUATRO. CONCLUSIONS This analysis points to barriers to quality care such as insufficient staffing, education/training, equipment and lack of quality management. It highlights the correlation between the human resources availability and quality of care. It has also identified common action items for enhancing quality of radiotherapy programmes in the Region.
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Affiliation(s)
- Joanna Izewska
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.
| | - Mary Coffey
- Discipline of Radiation Therapy, School of Medicine, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, Ireland
| | - Pierre Scalliet
- Department of Radiotherapy, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Eduardo Zubizarreta
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Tania Santos
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
| | - Ioannis Vouldis
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria
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Improving patient safety and workflow efficiency with standardized pretreatment radiation therapist chart reviews. Pract Radiat Oncol 2017; 7:339-345. [PMID: 28341319 DOI: 10.1016/j.prro.2017.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Radiation therapists play a critical role in ensuring patient safety; however, they are sometimes given insufficient time to perform quality assurance (QA) of a patient's treatment chart and documentation before the start of treatment. In this work, we show the benefits of introducing a formal therapist prestart QA checklist, completed in a quiet space well in advance of treatment, into our workflow. METHODS AND MATERIALS A therapist prestart QA checklist was created by analyzing in-house variance reports and treatment unit delays over 6 months. Therapists were then given dedicated time and workspace to perform their checks within the dosimetry office of our department. The effectiveness of the checklist was quantified by recording the percentage of charts that underwent QA before treatment, the percentage of charts with errors needing intervention, and treatment unit delays during a nearly 2-year period. The frequency and types of errors found by the prestart QA were also recorded. RESULTS Through the use of therapist prestart QA, instances of treatment unit delays were reduced by up to a factor of 9 during the first year of the program. At the outset of this new initiative, nearly 40% of charts had errors requiring intervention, with the majority being scheduling related. With upstream workflow changes and automation, this was reduced over the period of a year to about 10%. CONCLUSIONS The number of treatment unit delays was dramatically reduced by using a formal therapist prestart QA checklist completed well in advance of treatment. The data collected via the checklist continue to be used for further quality improvement efforts.
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Gopan O, Zeng J, Novak A, Nyflot M, Ford E. The effectiveness of pretreatment physics plan review for detecting errors in radiation therapy. Med Phys 2016; 43:5181. [DOI: 10.1118/1.4961010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Marks LB, Pawlicki TA, Hayman JA. Learning to Appreciate Swiss Cheese and Other Industrial Engineering Concepts. Pract Radiat Oncol 2015; 5:277-281. [PMID: 26362704 DOI: 10.1016/j.prro.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/26/2022]
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