Quality assurance guidelines for radiation treatment programs

December 31, 2015

Learn about the key quality elements for radiation treatment programs, and the key quality indicators to help assess and improve programs

This document highlights important elements of radiation quality assurance that should be common to all Canadian treatment programs. These guidelines shouldn’t replace detailed specifications, standard operating procedures or centre-based policies, but rather support the development and maintenance of a national quality-assurance strategy for radiation treatment.

Ultimately, the guidelines are to help assure the highest quality radiation treatment as an integrated part of cancer care, and to minimize the risk of medical errors and unexpected clinical outcomes.

At the highest operational levels, all cancer treatment organizations and provincial cancer agencies should take responsibility for implementing and monitoring quality assurance programs.

Quality assurance in radiation treatment is defined by the World Health Organization (WHO) as, “all procedures that ensure consistency of the medical prescription, and safe fulfillment of that prescription, as regards to the dose to the target volume, together with minimal dose to normal tissue, minimal exposure of personnel and adequate patient monitoring aimed at determining the end result of treatment” (WHO, 2008).

A quality assurance program must address all aspects of radiation treatment. That treatment includes the organization of programs, the qualifications of personnel involved in radiation treatment, the performance of planning and treatment equipment, policies and procedures and incident monitoring and reporting.

The Canadian Partnership for Quality Radiotherapy (CPQR) started in July 2010 between the Partnership and Canadian representatives from radiation oncology, medical physics and radiation therapy. The CPQR group works to develop guidance documents for the safe, high-quality delivery of radiation therapy, and to evaluate and report on the therapy’s quality.

The CPQR’s aims are to:

• Give guidance about quality assurance for Canadian radiation therapy programs to make sure the programs are consistent and high quality.
• Give guidance about technical quality control to make sure the technology and equipment used for radiation therapy is safe and used as planned.
• Develop a national system for reporting radiation therapy incidents to make sure that cancer centres across Canada can learn from each other and avoid mistakes.
• Evaluate how radiation therapy is delivered to patients based on quality and safety.

As well, Peer Review in Radiation is a national quality initiative to increase peer review for radiation treatment planning. Peer review not only catches medical errors, it reduces variability, improves processes for departmental policy and treatment planning, and continues medical education.

While peer view in Ontario is growing, this initiative maps out a strategy to increase peer review in radiation across all centres in Ontario, British Columbia, Alberta and, ideally, across Canada. Recently, Cancer Care Ontario identified the proportion of peer review in radiation cases as an indicator of quality care.

This initiative identifies local facilitators that will lead the peer review process to improve the rates in lagging Ontario centres and in the new Alberta and BC centres. Rates of peer review and outcomes of the process will also be collected. Support from national organizations with strong quality mandates (CPQR, CARO and, potentially, Accreditation Canada) will help develop a Canada-wide culture in which peer review practices are critical to improve radiation oncology’s quality.

For more information about Peer Review in Radiation, contact the Cancer Care and Epidemiology Cancer Research Institute at Queen’s University.

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