1. Radiotherapy Quality Assurance
Varian Medical Systems’ Perspective
Roman Wicha, PhD
Manager, Treatment Management System
Time-out
Errors deconstructed
IGRT is position QA
Additional reporting

2. Responsibility for Quality Assurance in RT
Published QA guidelines state that responsibility to design and execute a QA program belongs to the medical facility
Establish the type and frequency of QA tests
Reflect how the devices are used clinically
Covers the specific combinations of devices in the facility

3. Quality Assurance Machine (device) specific Patient Specific Process
Verifies correct operation of the device
Analyzes drifts from commissioning baseline
Patient Specific
Verifies patient specific data (e.g. treatment plan)
Procedure depends on patient treatment technique
Process
Verifies that clinical process is followed
Improves adherence to standards of care

4. Quality Assurance in radiotherapy clinics
QA is an integral part of the
Radiotherapy clinical process
Historical emphasis has been on Dosimetric QA
Routine Machine QA & Patient QA
Opportunity to round out QA in Radiotherapy
Incorporate complementary Process QA
CONFIDENTIAL

5. Modern Radiotherapy Process
Treatment prescription
Plan review & approval
Diagnostic imaging
Treatment planning
Target definition
Pre-treatment QA
Setup verification
Treatment delivery
User configurable: pre-defined far from the line of fire
Optional: May be applied at any point in the process, as appropriate
Reinforces best clinical practice
Different checklists can be used for different treatment techniques, more detailed for more complex procedures, less detailed for routine procedures
May require different levels of sign-off authority commensurate with the complexity or risk of the procedure
Can enforce mandatory completion before process can advance to next stage
Checks may be automatic or manual
Many opportunities for light-weight Process QA

6. Process QA via a checklist
Requires a change to current clinical practice
Other medical specialties have adopted “time-out” to resolve all concerns before beginning a procedure
E.g. The Universal Protocol
Can be implemented manually initially
Simple pen and paper approach is workable
Can be implemented within the devices eventually
Better compliance and auditing
Streamline checklist process

7. Checklist as a “time-out”
User Configurable
Optional
Content pre-defined far from the line of fire
May be used at any point in the process
Context specific
Rules-Based
Checks may be manual or automatic
Can enforce mandatory completion before process can advance to next stage
Reinforces adherence to clinical best practice
Risk-Adjusted
Sign-off levels commensurate with complexity or risk of procedure
Different checklists for different techniques
More details for more complex treatments
User configurable: pre-defined far from the line of fire
Optional: May be applied at any point in the process, as appropriate
Reinforces best clinical practice
Different checklists can be used for different treatment techniques, more detailed for more complex procedures, less detailed for routine procedures
May require different levels of sign-off authority commensurate with the complexity or risk of the procedure
Can enforce mandatory completion before process can advance to next stage
Checks may be automatic or manual

8. “Time-out” adopted by Surgeons
We anticipate that Radiotherapy will follow other medical specialties and adopt checklists to improve patient safety. We intend to facilitate this adoption within our software applications.

9. Checklist as a “Time-out” in Radiotherapy
Complements existing QA methodologies
Should increase compliance with current practice
Can be implemented at key points in the clinical process
More details for more complex or risky procedures
Can be implemented within the RT software
Makes it more practical

10. Thank you
CONFIDENTIAL