Quality assurance of 3D-CRT: indications and difficulties in their applications.

Although more advanced techniques such as intensity-modulated radiotherapy are rapidly spreading, 3D conformal radiotherapy (3D-CRT) remains the standard of treatment for many diseases. The authors outline essential indications to guarantee the quality of 3D-CRT treatments. Criteria for clinical indications and potential clinical advantages and disadvantages of 3D-CRT technology are presented. After briefly listing human and technological resources requirements, procedures for 3D-CRT and physical aspects peculiar to 3D-CRT are described. Medical physics support activities are also considered, including suggestions concerning quality control protocols. Difficulties in the application of correct quality procedures, particularly related to human and technological resources, procedures for patient positioning, imaging, contouring, treatment planning, in vivo dosimetry, set-up verification, follow-up, dose delivery are then discussed.

Are quality indicators for radiotherapy useful in the evaluation of service efficacy in a new based radiotherapy institution?

AIMS AND BACKGROUND: A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service (Istituto Superiore di Sanità) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit. PATIENTS AND METHODS: The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction). RESULTS: The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 +/- 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 +/- 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 +/- 10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance. CONCLUSIONS: The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results.