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