Quality and Safety in Radiotherapy

Preface

Quality and safety have always been important topics in the radiotherapy community. However, a single text that focuses on quality and safety does not exist. In attempting to provide such a reference, we decided to take the broadest possible view of qual- ity and safety.

We strove to encompass not only traditional, more technically oriented, quality assurance activities, but also gen- eral approaches of quality and safety. In order to achieve these goals, we sought contributions from experts both inside and outside our field. Through the choice of authors, we have also attempted to present a global view of the topics covered.

We have been in the midst of a transformation of quality and safety in radiotherapy. Among the key drivers of this trans- formation have been new industrial and systems engineering approaches. These approaches have come to the forefront in recent years following revelations of system failures (in both the scientific and public press) that have harmed radiotherapy patients and compromised quality.

The task of assuring quality is no longer viewed solely as a technical, equipment-dependent endeavor. Instead, it is now recognized for depending as much on processes and the people delivering the service.

Series Preface ........................................................................................................................... xi
Preface............................................................................................................................ xiii
Acknowledgments .....................................................................................................xv
Contributors ............................................................................................................... xvii

Part I Quality Management and Improvement

1 Perspective on Quality and Safety in Radiotherapy .....................................................3
2 Quality as Viewed and Lived by the Patient ........................................................7
3 Quality Management: An Overview ...................................................................... 11
4 Quality Management: Radiotherapy ............................................................................15
5 Development and Operation of a Quality Management Program: A Case Study........................................................................... 19
6 Methodologies for Quality Improvement........................................................................23
7 Lean Thinking and Quality Improvement...........................................................29
8 Process Control and Quality Improvement .......................................................................37
9 Access to Care: Perspectives from a Private Healthcare Environment..........................................43
10 Access to Care: Perspectives from a Public Healthcare Environment .................................47
11 Cost of Quality: Health Technology Assessment ........................................................... 53
12 Past, Present, and Future of Quality in Radiotherapy .......................................................59
13 Past, Present, and Future of Quality in Radiotherapy Physics...............................................63

Part II Patient Safety and Managing Error

14 Issues in Patient Safety ...............................................................................69
15 Overview of Risk Management.....................................................................73
16 Tools for Risk Management...................................................77
17 Error and Near-Miss Reporting: View from Europe ................................. 81
18 Error and Near-Miss Reporting: View from North America..................85
19 Impact of Cultural Biases on Safety................................................................95
20 Primer on High Reliability Organizing ..................................... 101
21 Errors in Patient Information Flow..................................................... 105
22 Identifying and Reducing Risk.................................................. 111
23 New Paradigm for Quality Management in Radiation Therapy Based on Risk Analysis.... 115
24 Risk Analysis and Control for Brachytherapy Treatments....................... 119

Part III Methods to Assure and Improve Quality

25 Medical Indicators of Quality: Terminology and Examples ...................................... 143
26 Medical Indicators of Quality: Structure, Process, and Outcome..................... 155
27 Role of Quality Audits: View from North America ...................... 161
28 Role of Quality Audits: View from the IAEA......................................... 167
29 Peer Review: Physician’s View from Australia ......................................... 171
30 Peer Review: Physicist’s View from North America............................................ 175
31 Overview of Credentialing and Certification .................................................... 179
32 Approach to Radiation Oncology Practice Accreditation......................................... 185
33 Clinical Trials: Credentialing .................................................... 191
34 Clinical Trials: Quality Assurance .......................................................... 197
35 Vendor’s Role in Quality Improvement.......................................................209

Part IV People and Quality

36 Role of Leadership................................................ 219
37 Human Factors Engineering: Overview............................................223
38 Human Factors Engineering: Radiotherapy Application..................................229
39 Human Factors Engineering: Case Study ....................................... 235
40 Changing Role of the Radiation Oncologist .................................... 241
41 Changing Role of the Medical Physicist .....................................................245
42 Staffing for Quality: Overview........................................................249
43 Staffing for Quality: Physics ................................................................................. 255
44 Role of Training ................................................................................................ 259
45 Practical Aspects of Training ...........................................................................................263

Part V Quality Assurance in Radiotherapy

46 CT Simulation .......................................................................................269
47 MRI and MRS Simulation......................................................277
48 Image Registration, Fusion, and Segmentation .........................................................283
49 4D Simulation ................................................................................ 291
50 Treatment Planning Systems...........................................299
51 External Beam Radiotherapy ................................................................................305
52 Linear Accelerator: Resource Analysis for Commissioning....................................... 311
53 Linear Accelerator: Implementation and Use.......................................... 317
54 Cobalt: Implementation and Use ...................................................... 323
55 Superficial and Orthovoltage: Implementation and Use............................................ 327
56 Computer-Controlled and Intensity-Modulated Radiotherapy ........................ 333
57 Intensity-Modulated Volumetric Arc Radiotherapy................................343
58 Four-Dimensional Treatment ................................................349
59 Combined Planning and Delivery Systems.................................... 353
60 Proton Radiotherapy ............................................................. 357
61 Stereotactic Radiosurgery and Stereotactic Radiation Therapy.......................... 361
62 Total Body Irradiation ................................................. 373
63 High Dose Rate Brachytherapy ...................................... 381
64 Electronic Brachytherapy............................... 397
65 Technical Guidance Documents ..............................405

Part VI Quality Control: Equipment

66 Dosimetry Equipment and Phantoms....................................... 411
67 Conventional Simulators..................................................... 417
68 Computed Tomography, Positron Emission Tomography, and Magnetic Resonance Imaging . 419
69 Stand-Alone External Beam Treatment Planning Systems............. 433
70 Conventional Linear Accelerators ......................439
71 Linear Accelerator–Based MV and kV Imaging Systems................443
72 Elekta Multileaf Collimator ................................447
73 Varian Multileaf Collimator ........................................................ 455
74 Siemens Multileaf Collimator.................................. 461
75 Integrated Systems: Tomotherapy..............................................465
76 Integrated Systems: GammaKnife .........................469
77 Integrated Systems: CyberKnife ...................................................... 473
78 Stand-Alone Localization Systems: Ultrasound ............................... 479
79 Stand-Alone Localization Systems: Transponder Systems ......................483
80 Stand-Alone Localization: Surface Imaging Systems.......................... 491
81 Mobile Electron Beam Intraoperative Radiation Therapy ..................495
82 Proton Radiotherapy .............................. 501
83 High-Dose-Rate Brachytherapy ..........................................507

Part VII Quality Control: Patient-Specific

84 External Beam Plan and MU Checks ............................ 513
85 Monte Carlo........................ 517
86 Patient Setup .......................................... 527
87 Motion Management.................................. 533
88 Total Skin Electron Therapy ............................... 537
89 Total Body Irradiation and Intensity-Modulated Total Marrow Irradiation ................541
90 Tomotherapy.........................................547
91 CyberKnife ....................................................... 553
92 Multileaf Collimator-Based Intensity-Modulated Radiotherapy................ 559
93 Compensator-Based Intensity-Modulated Radiotherapy...................565
94 Cranial Stereotactic Radiosurgery and Stereotactic Radiotherapy............... 571
95 Stereotactic Body Radiation Therapy ................ 575
96 Proton Radiotherapy ....................... 581
97 High-Dose-Rate Brachytherapy .........................585
98 Low-Dose-Rate Brachytherapy................... 593
99 Brachytherapy with Unsealed Sources.................................599
100 Intravascular Brachytherapy ......................603

Download Ebook PDF

Friday, September 23, 2022

Quality and Safety in Radiotherapy