The first text to focus solely on quality and safety in radiotherapy, this work encompasses not only traditional, more technically oriented, quality assurance activities, but also general approaches of quality and safety. It includes contributions from experts both inside and outside the field to present a global view. The task of assuring quality is no longer viewed solely as a technical, equipment-dependent endeavor. Instead, it is now recognized as depending on both the processes and the people delivering the service. Divided into seven broad categories, the text covers:
- Quality Management and Improvement includes discussions about lean thinking, process control, and access to services.
- Patient Safety and Managing Error looks at reactive and prospective error management techniques.
- Methods to Assure and Improve Quality deals broadly with techniques to monitor, assure, and improve quality.
- People and Quality focuses on human factors, changing roles, staffing, and training.
- Quality Assurance in Radiotherapy addresses the general issues of quality assurance with descriptions of the key systems used to plan and treat patients and includes specific recommendations on the types and frequencies of certain tests.
- Quality Control: Equipment and Quality Control: Patient-Specific provides explicit details of quality control relating to equipment and patient-specific issues.
Recently, a transformation of quality and safety in radiotherapy has begun to take place. Among the key drivers of this transformation have been new industrial and systems engineering approaches that have come to the forefront in recent years following revelations of system failures. This book provides an approach to quality that is long needed, one that deals with both human and technical aspects that must be the part of any overall quality improvement program.
Table of Contents
Part I Quality Management and Improvement
A Perspective on Quality and Safety in Radiotherapy
Quality as Viewed and Lived by the Patient
Quality Management: An Overview
Quality Management: Radiotherapy
Development and Operation of a Quality Management Program: Case Study
Methodologies for Quality Improvement
Lean Thinking and Quality Improvement
Process Control and Quality Improvement
Access to Care: Perspectives from a Private Healthcare Environment
Access to Care: Perspectives from a Public Healthcare Environment
The Cost of Quality: Health Technology Assessment
The Past, Present, and Future of Quality in Radiotherapy
Past, Present, and Future of Quality in Radiotherapy Physics
Part II Patient Safety and Managing Error
Issues in Patient Safety
An Overview of Risk Management
Tools for Risk Management
Error and Near-Miss Reporting: A View from Europe
Error and Near-Miss Reporting: A View from North America
The Impact of Cultural Biases on Safety
A Primer on High Reliability Organizing
Errors in Patient Information Flow
Identifying and Reducing Risk
A New Paradigm for Quality Management in Radiation Therapy Based on Risk Analysis
Risk Analysis and Control for Brachytherapy
Part III Methods to Assure and Improve Quality
Medical Indicators of Quality: Terminology and Examples
Medical Indicators of Quality: Structure, Process, and Outcome
The Role of Quality Audits: A View from North America
The Role of Quality Audits: A View from the IAEA
Peer Review: A Physician’s View from Australia
Peer Review: A Physicist’s View from North America
An Overview of Credentialing and Certification
An Approach to Radiation Oncology Practice Accreditation
Clinical Trials: Credentialing
Clinical Trials: Quality Assurance
The Vendor’s Role in Quality Improvement
Part IV People and Quality
The Role of Leadership
Human Factors Engineering: An Overview
Human Factors Engineering: A Radiotherapy Application
Human Factors Engineering: A Case Study
The Changing Role of the Radiation Oncologist
The Changing Role of the Medical Physicist
Staffing for Quality: Overview
Staffing for Quality: Physics
The Role of Training
Practical Aspects of Training
Part V Quality Assurance in Radiotherapy
MRI and MRS Simulation
Image Registration, Fusion, and Segmentation
Treatment Planning Systems
External Beam Radiotherapy
Linear Accelerator: Resource Analysis for Commissioning
Linear Accelerator: Implementation and Use
Cobalt: Implementation and Use
Superficial and Orthovoltage: Implementation and Use
Computer-Controlled and Intensity-Modulated Radiotherapy
Intensity-Modulated Volumetric Arc Radiotherapy
Combined Planning and Delivery Systems
Stereotactic Radiosurgery and Stereotactic Radiation Therapy
Total Body Irradiation
High Dose Rate Brachytherapy
Technical Guidance Documents
Part VI Quality Control: Equipment
Dosimetry Equipment and Phantoms
Computed Tomography, Positron Emission Tomography, and Magnetic Resonance Imaging
Stand-Alone External Beam Treatment Planning Systems
Conventional Linear Accelerators
Linear Accelerator–Based MV and kV Imaging Systems
Elekta Multileaf Collimator
Varian Multileaf Collimator
Siemens Multileaf Collimator
Integrated Systems: Tomotherapy
Integrated Systems: GammaKnife
Integrated Systems: CyberKnife
Stand-Alone Localization Systems: Ultrasound
Stand-Alone Localization Systems: Transponder Systems
Stand-Alone Localization: Surface Imaging Systems
Mobile Electron Beam Intraoperative Radiation Therapy
Part VII Quality Control: Patient-Specific
External Beam Plan and MU Checks
Total Skin Electron Therapy
Total Body Irradiation and Intensity-Modulated Total Marrow Irradiation
Multileaf Collimator-Based Intensity-Modulated Radiotherapy
Compensator-Based Intensity-Modulated Radiotherapy
Cranial Stereotactic Radiosurgery and Stereotactic Radiotherapy
Stereotactic Body Radiation Therapy
Brachytherapy with Unsealed Sources
Todd Pawlicki and Arno J. Mundt work in the Department of Radiation Oncology at the University of California, San Diego.
Peter Dunscombe works in the medical physics department at the Tom Baker Cancer Center.
Pierre Scalliet works in the Department of Radiation Oncology at the St. Luc University Hospital.
it goes well beyond [quality assurance tests] and tackles quality at the highest levels of management and strategy. Virtually every aspect of quality and safety in radiotherapy is dissected … it serves as an excellent starting point and contains many references for further reading. I can therefore see this book being an extremely useful first reference for any manager wishing to review their current quality management practices. It is up-to-date in terms of technology and the latest thinking on quality management programmes, and contains several practical case studies and worked examples. …perhaps it is time for all of us to re-think our quality programmes, and this book would certainly be a valuable starting point.
—Keri Owen, Scope, December 2011
The contents and layout are excellent.
—Professor Eric E. Klein, Washington University School of Medicine
…well written and easy to read. Because of its comprehensive nature, students as well as seasoned radiation therapy professionals will find this book useful. … No one book contains the range of topics covered in this book. There are books devoted to quality assurance of radiotherapy devices which go into much more detail on each device. There are books on quality management, human factors engineering, and error prevention which are not written in the context of radiotherapy. In this book, the authors provide a brief review of all these topics with enough detail to convey the salient points needed to understand the fundamentals. Each chapter includes a wealth of references which readers can use to supplement the material in this book. This is an important reference on critically important topics.
—Arthur Olch, PhD, FAAPM, Children's Hospital Los Angeles, Doody's Review Service, June 2011