Quality in Radiation Therapy:
what is it and how do you achieve it?
1.
2.
Overview of definitions and approaches to Quality
Pawlicki
ROSIS
Knöös
3.
Peer Review Quality Audits
Halvorsen
4.
The Regulator’s Viewpoint
Zelac
QA in IGRT
Bissonnette
Evidence Based QA
Dunscombe
5.
6.
Peer reviews for clinical physicists:
What / Why?
What: A review by an impartial, experienced colleague focused entirely
on providing the incumbent physicist with constructive
suggestions for improving quality & safety.
Why:
–
–
–
–
Safety
Quality
Reimbursement
Regulatory requirement
Key motives
(Other catalysts)
Peer reviews to enhance & validate quality
•
Recent developments favoring peer reviews for physicists
–
–
–
–
–
•
Regulatory
Payors
Professional organizations
IoM reports
ABR MOC
Types of clinical physics peer reviews
–
–
–
–
Accrediting organizations (ACR, ACRO)
Formal, private reviews (TG-103)
RPC audit
ABR-qualified, AAPM-operated PQI program?
Regulatory example: NY state
Payor pressure: Blue Cross
AAPM recommendation:
IoM report:
“Recommendation 7.2:
Performance standards and expectations for health professionals
should focus greater attention on patient safety.
Health professional licensing bodies should:
(1) Implement periodic reexamination and relicensing of doctors,
nurses and other key providers, based on both competence
and knowledge of safety procedures, and
(2) Work with certifying and credentialing organizations to develop
more effective methods to identify unsafe providers and take
action.”
ABR’s MOC:
ACR Accreditation:
•
Comprehensive review of entire clinical program
–
–
–
–
•
Physicians must agree to be reviewed as well
Somewhat expensive ($9K)
The reviewed entity is the organization
Formal process to ensure the report is unbiased
Physics component:
–
–
–
–
Benchmarked against TG recommendations & ACR standards
Review of calibration & commissioning reports, instruments
One-day on site review by an experienced physicist
Includes review of clinical charts & treatment plans / dose calcs
Physicist peer reviews per TG-103:
Context:
Main components:
• Formal arrangement with an outside QMP.
• Annual review if new equipment, new services, or physics
staffing changes; otherwise every 3 years.
• Review follows a defined scope and format to ensure some
level of consistency and effectiveness of reviews.
• Review includes an on-site visit with careful assessment of
instruments, calibration records, treatment planning / dose
calculation conventions, and physics documentation.
• Formal written report addressed to the physicist, with
recommendations for improvement.
Topics reviewed:
• Independent verification of accelerator outputs – verify TLD
reports within past year, or perform independent measurement.
• Chart audit of ≥5 randomly selected patient charts, with
emphasis on dosimetry calculations, physicist check/approval,
accurate treatment history record, and tx plan documentation.
• Review of the QC & QA programs in place and consistency of
implementation.
• Assess physics staffing/coverage relative to the scope and
volume of clinical services provided.
• Assess support for instrumentation, service agreements, and
professional development.
Checklists:
Checklists:
Checklists:
Checklists:
Summary:
• Peer reviews for quality improvement are becoming increasingly
common in medicine, and medical physics is no exception.
• The AAPM has formulated a mechanism for such reviews in
clinical radiotherapy physics.
• From personal experience as both a reviewer and the reviewed,
the process is an effective component of a quality improvement
program and does not unduly disrupt the incumbent’s clinical
work flow.