1st Edition

Quality and Safety in Radiotherapy

ISBN 9781439804360
Published December 20, 2010 by CRC Press
643 Pages - 192 B/W Illustrations

USD $190.00

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Book Description

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

CT Simulation

MRI and MRS Simulation

Image Registration, Fusion, and Segmentation

4D Simulation

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

Four-Dimensional Treatment

Combined Planning and Delivery Systems

Proton Radiotherapy

Stereotactic Radiosurgery and Stereotactic Radiation Therapy

Total Body Irradiation

High Dose Rate Brachytherapy

Electronic Brachytherapy

Technical Guidance Documents

Part VI Quality Control: Equipment

Dosimetry Equipment and Phantoms

Conventional Simulators

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

Proton Radiotherapy

High-Dose-Rate Brachytherapy

Part VII Quality Control: Patient-Specific

External Beam Plan and MU Checks

Monte Carlo

Patient Setup

Motion Management

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

Proton Radiotherapy

High-Dose-Rate Brachytherapy

Low-Dose-Rate Brachytherapy

Brachytherapy with Unsealed Sources

Intravascular Brachytherapy

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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