Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Abstract

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

Competencies of therapeutic radiographers working in the linear accelerator across Europe: A systematic search of the literature and thematic analysis

“…Quality and risk management Risk management e Perform risk and hazard analysis in the workplace e Reduce risks and hazards for patients and staff e Ensure appropriate workload for safe practice e Report incidents and near-misses 23,24,27,33,34,38e42 Quality improvement e Contribute to the continuous improvement of practice e Analyse errors and near-misses and ensure prevention of future events e Develop technology and its application into practice 19,27,28,33,34,41,43e45 Radiation protection e Recognise the radiation hazards in the workplace e Ensure protection of staff and public against radiation e Ensure protection of patients against radiation e Adhere to the use of personal dosimeters e Know and adhere to legislation regarding radiation protection 19,23,24,27,28 Justification e Be able to select a suitable treatment, based on own analysis e Critically question radiological referrals e Refuse to carry out an exposure which, in one's professional opinion, is inadvisable 19,23,24,27 Optimisation e Maintain ALARA principle e Minimise dose to normal tissues 19,23,27 Carry out audits e Develop and implement audit programmes 27,46 Evidence-based practice e Apply relevant scientific evidence into practice e Take decisions based on scientific evidence e Apply results of research into practice 19,23,24,27,28,34,41 Individual professional development e Continuously assess their own competencies, knowledge and skills e Ensure their own professional development 19,27,34,41e43,45 Development of the profession e Contribute to the profiling of the profession e Contribute to the content-related development of the profession 27 Protocols, standards, guidelines and regulations e Implement professional standards into professional practice e Adhere to legal regulations e Follow national and international guidelines e Implement institutional protocols into practice 19,23,24,27,38,41 ...…”

“…White literature 33,38,39,43,44,46,49,53 mostly discussed the less well-established competencies (e.g. participating in audits).…”

“…"Take individual responsibility for carrying out work in a safe manner" 27(p6) "Accept responsibility for one's own actions within the scope of professional practice" 19(p30) "Accurately prepare and deliver a course of treatment" 28(p7) "Carry out treatment preparation and delivery based on best practice at all times" 24(p19) "Address identified gaps in the knowledge, skills, and judgment within [TRs] scope of practice" 34(p104) Research According to the literature found, "research and development [is] an essential component for a new staffing model [for TRs]" 41(p390) and the TRs should be autonomous and undertake responsibility for audits and research (including trials). 19,24,27,41,46 In addition, it is part of their competencies to "disseminate results of clinical audit and research" 27(p12) and "participate in the implementation of the research findings" 24(p43) Recording and handling data…”

Feasibility study of silica bead thermoluminescence detectors (TLDs) in an external radiotherapy dosimetry audit programme

“…Radiotherapy audit provides an external independent assessment of the dosimetry and can help to identify possible improvements and also find issues which may need addressing immediately [1,2,3,4,5,6].…”

Remote dosimetric auditing of clinical trials: The need for vendor specific models to convert images to dose

“…Quality assurance (QA) is an essential procedure to assess accuracy of relevant parameters in radiotherapy 1 while an external audit is recommended to assess consistency of local QA and effectiveness of delivery and measurement systems. 2 The importance of external audits is emphasized in radiotherapy clinical trials where a consistent accuracy is essential. [3][4][5] Conventional audits are performed by sitevisits or postal methods, which can be expensive and/or labor intensive.…”