Annual AAPM 2013 Meeting
M. Saiful Huq, Ph.D., Pittsburgh University Medical Center, Pittsburgh, Pennsylvania, 15232 United States
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Modern radiation therapy is becoming more and more complex. To maintain a high level of safety, medical physicists shift their approach to safety from historical to formal. Quality assurance is not a unique challenge to radiotherapy, not to mention medicine. Every industry has an approach to measuring, maintaining and assuring quality. Industrial and professional standards provide criteria and guidelines for the type, frequency and specifications for quality tests. In each case, domain-specific expertise is required to design quality assurance processes and manage the workflow in the information. Workflow for radiation therapy is not extremely complicated but contains many steps and points of interaction, and mistakes can be catastrophic and systemic. In the past, the level of complexity was considered to be low enough to allow team members to manage and take separate steps in the quality assurance chain. This does not mean that in the past the error rates were lower; the lack of exhaustive error reporting does not allow such an analysis. Review of the limited error reporting data as well as anecdotal evidence suggest that errors occurred at least as high as they are now. Patient mistakes, inaccurate computations, mistakes in the use of ancillary devices are too common, and the rate of these errors may have fallen due to greater dependence on computers in planning and monitoring of treatment.
If increased complexity has not led to a QA radiotherapy review, it is a catalyst for this change. For example, the computerization of the radiation therapy workflow has reduced dependence on the choice of the accessory therapist but has increased dependence on the right choice of accessory and a continuous chain in the flow of information from planning to delivery. Another important contribution to the review of the CC paradigm was the increased complexity of the treatment plan. Once 3-4 block-defined fields were used, there are now literally hundreds of dynamically supplied subfields, each of which would have been considered unverified in the past.
The goal of QA radiotherapy, and more generally, QM, is to continue to improve the error rate while maintaining or even improving the speed, efficiency, and even effectiveness of the process. The formal quality management programs, part of which are part of the QA, contain the following components: safety culture, quality support, quality measurement and feedback loops, continuous improvement of quality, process control, education and training and management of mistakes. This symposium will define these terms and introduce the radiotherapy medical physicist in the efforts of AAPM and other QM and QA workflow formers to further improve the radiotherapy safety record.
1: Understand the need for formal QM and QA processes
2: Understand formal QM and QA techniques
3: Understand how formal QM and QA techniques apply to radiation therapy
Funding, Disclosure and Conflict of Interest: Lecturer George Sherrow is employed by Landauer Medical Physics, which provides commissioning services.