1
|
Kron T, Fox C, Ebert MA, Thwaites D. Quality management in radiotherapy treatment delivery. J Med Imaging Radiat Oncol 2022; 66:279-290. [PMID: 35243785 DOI: 10.1111/1754-9485.13348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022]
Abstract
Radiation Oncology continues to rely on accurate delivery of radiation, in particular where patients can benefit from more modulated and hypofractioned treatments that can deliver higher dose to the target while optimising dose to normal structures. These deliveries are more complex, and the treatment units are more computerised, leading to a re-evaluation of quality assurance (QA) to test a larger range of options with more stringent criteria without becoming too time and resource consuming. This review explores how modern approaches of risk management and automation can be used to develop and maintain an effective and efficient QA programme. It considers various tools to control and guide radiation delivery including image guidance and motion management. Links with typical maintenance and repair activities are discussed, as well as patient-specific quality control activities. It is demonstrated that a quality management programme applied to treatment delivery can have an impact on individual patients but also on the quality of treatment techniques and future planning. Developing and customising a QA programme for treatment delivery is an important part of radiotherapy. Using modern multidisciplinary approaches can make this also a useful tool for department management.
Collapse
Affiliation(s)
- Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Institute of Oncology, Melbourne University, Melbourne, Victoria, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chris Fox
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Martin A Ebert
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, Mathematics and Computing, University of Western Australia, Perth, Western Australia, Australia.,5D Clinics, Perth, Western Australia, Australia
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia.,Medical Physics Group, Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| |
Collapse
|
2
|
Chilkuri M, Millar J, Adams G. 'With great power comes great responsibility': An impetus for quality and safety in radiation oncology. J Med Imaging Radiat Oncol 2022; 66:242-248. [PMID: 35243779 DOI: 10.1111/1754-9485.13377] [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: 08/31/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
Strict quality control and vigilance at every step is essential to maintain rigour and ensure quality and safety in radiation oncology. The scientific knowledge and technological capabilities we possess give us enormous power to deliver specialised and complex treatments and improve health outcomes for our cancer patients. However, this requires development of whole system performance and its evaluation against established standards and benchmarks. It calls for organisational commitment and active participation of managers and clinical teams in quality improvement initiatives. In addition to medical physicists and radiation therapist, radiation oncologists, including trainees, must accept important leadership responsibilities to maintain a positive safety culture.
Collapse
Affiliation(s)
- Madhavi Chilkuri
- Radiation Oncology, Townsville University Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Jeremy Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gerard Adams
- Radiation Oncology, Genesis Care, Bundaberg, Queensland, Australia
| |
Collapse
|
3
|
McCann LJ, Peden J, Phipps E, Plugge E, O'Moore EJ. Developing gender-specific evidence-based standards to improve the health and wellbeing of women in prison in England: a literature review and modified eDelphi survey. Int J Prison Health 2019; 16:17-28. [PMID: 32040276 DOI: 10.1108/ijph-02-2019-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE There are significant health inequalities experienced by women in prison. They face distinct challenges and have particular and complex needs, specifically with regard to their physical and mental health. The purpose of this paper is to describe the approach taken to develop a set of health and wellbeing standards for the women's prison estate in England, which can be applied elsewhere. DESIGN/METHODOLOGY/APPROACH A structured literature review of standard healthcare databases and grey literature was used to inform development of suggested standards. A multidisciplinary expert panel provided consensus on the standards through an online survey and women with a history of contact with the criminal justice system were consulted through consensus groups. FINDINGS A total of 549 papers were included in the final review. From this, 127 standards were identified for inclusion in the Delphi process. Consensus was achieved on all standards; this, combined with the analysis of qualitative feedback provided by both the survey and the consensus groups, resulted in the development of 6 overarching principles and 122 standards, across ten topic areas. ORIGINALITY/VALUE These standards are the most extensive that are known to exist for health and wellbeing of women in prison and the first to be developed in England. The process used ensures the standards have high validity, acceptability and feasibility and can be used to support those developing similar methodologies. There are few papers which document the development of standards to improve health and to the authors knowledge, only one other paper has been published detailing the development of health standards in prison settings specifically.
Collapse
Affiliation(s)
- Lucy J McCann
- National Health and Justice Team, Public Health England, London, UK
| | - Jo Peden
- National Health and Justice Team, Public Health England, London, UK
| | - Emily Phipps
- Oxford School of Public Health, University of Oxford, Oxford, UK
| | - Emma Plugge
- WHO UK Collaborating Centre for Health in Prisons Programme, Public Health England, London, UK
| | - Eamonn J O'Moore
- National Health and Justice Team, Public Health England, London, UK.,WHO UK Collaborating Centre for Health in Prisons Programme, Public Health England, London, UK
| |
Collapse
|
5
|
Mayo CS, Pisansky TM, Petersen IA, Yan ES, Davis BJ, Stafford SL, Garces YI, Miller RC, Martenson JA, Mutter RW, Choo R, Hallemeier CL, Laack NN, Park SS, Ma DJ, Olivier KR, Keole SR, Fatyga M, Foote RL, Haddock MG. Establishment of practice standards in nomenclature and prescription to enable construction of software and databases for knowledge-based practice review. Pract Radiat Oncol 2016; 6:e117-e126. [PMID: 26825250 DOI: 10.1016/j.prro.2015.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 09/05/2015] [Accepted: 11/02/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Establishment of standards within a practice and across disease site groups for nomenclatures, prescription formatting, and measured dose-volume histogram (DVH) metrics is a key enabling step for creating software and database solutions to make routine aggregation of dosimetric data for all patients treated in a practice, practical. A process of physician-driven, iterative dialogs coupled with development of technical tools is required to implement the cultural and procedural changes. The cumulative reward for this effort is a database that can be used for defining practice norms, benchmarking against national standards, and tracking dosimetric effects of longitudinal practice pattern changes. METHODS AND MATERIALS A 4-year project was carried out to develop and introduce standardizations, modify processes, and develop computer-based tools for reporting, aggregation, and analysis of prescription and DVH metrics. Physician disease site groups developed 42 target and 81 normal tissue templates. From the database of 32,002 DVH metrics, benchmarking was illustrated for a subgroup of breast (281) and prostate (324) patients treated with conventional fractionation over a 16-month period. Breast patients were segregated according to prescription template used: simple (S, tangents only) vs complex (C, tangents + supraclavicular ± intramammary nodes) and left (S-L or C-L) versus right (S-R or C-R). RESULTS Prostate patients' median and 50% confidence intervals (CIs) for bladder, stated according to the nomenclature: the percentage of bladder volume receiving doses of ≥40 Gy (V40[%]), V65Gy[%], V70Gy[%], V75Gy[%], and V80Gy[%] were 45.5 (24.9-57.0), 15.6 (9.0-23.8), 7.6 (3.3-13.6), 2.0 (0.0-7.9), and 0.0 (0.0-1.4), respectively. Values for rectum: V50Gy[%], V60 Gy[%], V65Gy[%], V70Gy[%], and V75Gy[%] were 37.1 (27.8-43.5), 21.8 (15.6-25.5), 14.6 (9.6-18.0), 7.7 (1.9-12.3), and 1.0 (0-7.0), respectively. For breast patients, heart:mean Gray values were 1.5 (1.0-2.0), 3.1 (2.2-4.8), 0.4 (0.3-0.7), and 1.1 (0.8-2.2) for S-L, C-L, S-R, and C-R, respectively. Longitudinal, moving window plots of median, 50% CI, and 90% CI for 6-month periods demonstrated the effect of practice changes to reduce heart doses. CONCLUSIONS Standardization was challenging as a practice change, but has resulted in significant improvements for both our clinical and research efforts.
Collapse
Affiliation(s)
- Charles S Mayo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | | | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth S Yan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Scott L Stafford
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Mirek Fatyga
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|