QUALITY INDICATION FOR MEASUREMENT

OF PERFORMANCE CHARACTERISTICS OF

RADIATION ONCOLOGY

Quality assurance (QA) in Radiotherapy

is 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 the treatment

Quality Indicators

General Quality Indicators

Medical Physics Indicators

Accuracy and Technical complex cities of treatment

Indicators

Patient Satisfaction Indicators

Facility Management

STAFF RECORD

Details of registration /qualifications of whole staff is available with HR

department.

Available with our RSO for AERB records- was checked

Attendance records are maintained for DNB classes & Tumor boards

Records of regular performance review –

DNB students available within department

Other staff with HR department.

STAFF Recommendations At our center

Radiation oncologist-in-chief

One per programme One

Staff radiation oncologist

One additional/ 200–250 patients treated annually

5 staff radiation oncologist

Radiation physicist One per centre for up to 400 patients annually.

5 radiation physicist

RTT-Sim RTT Two for every 500 patients simulated annually

2 available for every 500 patients 1 available at CT simulator

RTT Supervisor One per centre 1 supervisor

RTT Four per megavoltage unit

4 available per megavoltage unit

Radiation Oncology Record Management Audit evidence of patients treated with RT is maintained by MRD

department

Shortcoming

Non availability of older records (before 2011)

Data not completely available in computer backup

Patients information records with RT numbers available at reception

Radiotherapy treatment cards available but conversion to soft copy

will take some more time

Facility Process Management

Waiting time is been recorded at the level of each machine and

also by biomedical engineer

Jan 2011- Dec 2011

Linac 1 124 hr(3.08%)

Linac 2 93.40 hr(2.3%)

Linac 3 146 hr(3.64%)

Linac 4 286.10 hr(7.1%)

Linac 5 38.5hr(6.4%) started in Nov2011

Simulator 22.30hr(3.6%)

Analysis of waiting time to start treatment

Curative/radical Pre-operative

Post-operative Palliative

Standard good care

≤30 d/patient

≤15

d/patient ≤60

d/patient≤10

d/patient

At our center ≤5-7 days ≤2 days ≤ 7 days ≤1 days

Treatment Planning And DeliveryRadiation treatment prescription

10 files were randomly analyzed for consent policies.

Available in all files.

Will repeat again after 6 months to rule out the bias

Planning ProceduresPlanning Procedures

Guidelines for treatment planning of all tumour sitesGuidelines for treatment planning of all tumour sites

are created as per international standardsare created as per international standards

Quality Indicators for Medical Physics

Equipment

Records of commissioning data for LINAC 5 are maintained in department

as per international standards

Quality assurance program

Adsorbed dose values taken on individual machines

(attached output for LINAC 2 and 3)

• QA with arc check for LINAC 5 Checked for 5 patients

(results attached)

• Patient dose matched with phantom on machine for 7 patients (within 2%)

(data sheet attached).

Conventional calculations are crosschecked by another physicist

Radiation Treatment Delivery

Records of patient available on each machine

Monitoring of patients during treatment done every week

Verification system available only on 3 machines

With installation of next machine

– will upgrade the documentation

- at present available in registers and RT cards

MOIST DESQUAMATION

HEAD & HEAD & NECKNECK

BREASTBREAST CHESTCHEST PELVISPELVIS

Stated in Stated in literatureliterature

10-15%10-15% <10%<10% 5%5% 10%10%

In our set upIn our set up 4-5%4-5% 5%5% 2%2% 5%5%

Head & Neck

Grade 3 4

Mucosa

In literature 25% 0%

Our setup 70-80% 0%

AcuteAcuteLate effects

Xerostomia- in literature <25% our set up -(30-40%)

Large size tumours

Abdominal & Pelvic Irradiation

Acute effects

literature our set up

•Diarrhea- <10% 5-7%

•Hematologic -<6% 10%

Patient satisfaction Indicators(30 people)

Filled by Patient

Attendant

94%

6%

Age 18-35

56-70

>70

33%

33%

33%

Profession Professional

Traders

Retired

40%

20%

30%

First visit Yes

No

10%

90%

Instruction Primary

High school

University

16%

33%

50%

Patient satisfaction IndicatorsType of visit Therapy

Followup

40%

60%

Quality of visit Desk staff Very satisfied

Time frame Satisfied -33%

Very satisfied- 67%

Promptness of doctors Very satisfied

Case sheet collecting procedures

Satisfied -16.6%

Very Satisfied -83.4%

Facilities Satisfied -16.6%

Very Satisfied -83.4%

Overall rating Very satisfied

recommendations Highly -33.3%

Recommended-67%

Future directions

Data collections need to be streamlined

Protocols need to be created for treatment

Verifications protocols have to be developed

Need to develop our own indicators for reaction

assessment