This document discusses quality assurance indicators for radiation oncology facilities and treatment. It outlines general, medical physics, treatment accuracy and complexity, and patient satisfaction indicators. It provides details on staffing records, recommendations, treatment planning, equipment quality assurance, treatment delivery, acute and late effects for different treatment sites, and results of patient satisfaction surveys. Overall it evaluates the performance and quality of a radiation oncology facility based on various quality indicators.

1. QUALITY INDICATION FOR MEASUREMENT
OF PERFORMANCE CHARACTERISTICS OF
RADIATION ONCOLOGY

2. Quality assurance (QA) in Radiotherapy
is a ll p ro c e d ure s tha t e ns ure c o ns is te nc y o f the m e d ic a l
p re s c rip tio n, a nd s a fe fulfillm e nt o f tha t p re s c rip tio n, a s
re g a rd s to the d o s e to the ta rg e t vo lum e , to g e the r with
m inim a l d o s e to no rm a l tis s ue , m inim a l e x p o s ure o f
p e rs o nne l a nd a d e q ua te p a tie nt m o nito ring a im e d a t
d e te rm ining the e nd re s ult o f the tre a tm e nt

3. Quality Indicators
 General Quality Indicators
 Medical Physics Indicators
 Accuracy and Technical complex cities of treatment
Indicators
 Patient Satisfaction Indicators

4. 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.

5. STAFF
Recommendations At our center
Radiation oncologist-in-chief One per programme One
Staff radiation oncologist One additional/ 200–250 5 staff radiation oncologist
patients treated annually
Radiation physicist One per centre for up to 5 radiation physicist
400 patients annually.
RTT-Sim RTT Two for every 500 patients 2 available for every 500
simulated annually patients
1 available at CT simulator
RTT Supervisor One per centre 1 supervisor
RTT Four per megavoltage unit 4 available per megavoltage
unit

6. 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

7. 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%)

8. Analysis of waiting time to start treatment
Curative/radical Pre- Post-operative Palliative
operative
Standard good ≤30 ≤15 ≤60 ≤10
care d/patient d/patient d/patient d/patient
At our center ≤5-7 days ≤2 days ≤ 7 days ≤1 days

9. Treatment Planning And Delivery
Radiation 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 Procedures
 Guidelines for treatment planning of all tumour sites
are created as per international standards

10. Quality Indicators for Medical Physics

11. 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

12. 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

13. MOIST DESQUAMATION
HEAD & BREAST CHEST PELVIS
NECK
Stated in 10-15% <10% 5% 10%
literature
In our set up 4-5% 5% 2% 5%

14. Head & Neck
Acute
Late effects
Grade 3 4 Xerostomia-
Mucosa in literature <25%
our set up -(30-40%)
In literature 25% 0%
Our setup 70-80% 0%
Large size tumours

15. Abdominal & Pelvic Irradiation
Acute effects
literature our set up
•Diarrhea- <10% 5-7%
•Hematologic -<6% 10%

16. Patient satisfaction Indicators(30 people)
Filled by Patient 94%
Attendant 6%
Age 18-35 33%
56-70 33%
>70 33%
Profession Professional 40%
Traders 20%
Retired 30%
First visit Yes 10%
No 90%
Instruction Primary 16%
High school 33%
University 50%

17. Patient satisfaction Indicators
Type of visit Therapy 40%
Followup 60%
Quality of visit Desk staff Very satisfied
Time frame Satisfied -33%
Very satisfied- 67%
Promptness of doctors Very satisfied
Case sheet collecting Satisfied -16.6%
procedures Very Satisfied -83.4%
Facilities Satisfied -16.6%
Very Satisfied -83.4%
Overall rating Very satisfied
recommendations Highly -33.3%
Recommended-67%

18. 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