more QA

radioactive sources

• inventory and security

• policies and procedures P & P

• need a hot lab to store LDR sources

equipment safety

• design

• shielding

• workload calcs

• personnel monitoring

• imaging devices, optimal technique/protocol

culture of safety

• every member of department

• organized & supported

• chart rounds

• error monitoring

• m & m rounds

• lifelong learning

• adequate staffing

essential elements of radiation safety

• accreditation

• equipment calibration

• safety program

• patient into system

• tx planning

• QM program

• radiation safety

• qualified staff

• peer review

• multidisciplinary

additional requirements

error reporting

after simulation

• target delineation

• plan generation

• QA and analysis

• tx push

• final checks

• tx setup & delivery

monitoring professional performance

• initial certification

• state license

• continuing education

• peer review (MD: rx and target localization, chart rounds, multidisciplinary)

• recertification

pt centered QM

• general medical issues

• access to multidisciplinary care/specialist

• outcome assessment (RTOG toxicity scoring)

• outcomes registry

• QA for standard tx approach

typical QA process per pt

pt setup/positioning, cross sectional imaging, contouring, tx intent, prescription, tx plan/dose calc, MU, IMRT sequencing, Echart prep, plan eval, data transfer, pt specific QA, pt setup/delivery, plan verification, modify?, weekly chart checks

equipment and devices

• system specification (pre purchase)

• connectivity

• acceptance testing

• clinical commissioning

• clinical release (training & documentation, ongoing QA)

brachytherapy devices

• sealed sources in HDR, LDR, unsealed sources in NM, electronic brachy, liquid sources, IV brachy

• associated applicators, hardware, tx planning, radiation safety equipment

imaging systems

CT sim, CBCT, US, PET, MR

3D computerized tx planning

CT import, registration, contouring, dose calcs, plan review tools (DVH, isodose lines), connectivity w/ tx delivery system

tx management systems

• varis, mosaiq

• connectivity: dept, network, hospital EMR, ancillary equipment, billing (HL 7), pt demographics (ADT)

specialized techniques or devices

• stereotactic

• intraop

• electronic brachy

• respiratory gating

IOM publication

• delivery high quality cancer care: charting new course for a system in crisis

• US: 14 million had ca

• crisis coming: growing demand, increased complexity, rising costs, shrinking workforce