Quality Assurance (QA) measures are a standard part of radiation therapy. But given that these measures are often carried out in combination with one another, it's difficult, if not impossible, to know which are actually effective.
A team of researchers from Johns Hopkins, working in collaboration with a group from Washington University in St. Louis, set out to understand the impact of commonly used QA measures including physician plan review, physics chart checks, port films and checklists. They found significant variation in the effectiveness of individual measures. Moreover, no single QA check was able to detect patient safety errors 100% of the time.
According to an abstract presented at the American Association of Physicists in Medicine (AAPM), the researchers started by reviewing 4,407 near miss events that occurred at their institutions between 2008 and 2010. Of the 4,407 events, they identified 250 which, had they not been caught, could have resulted in serious harm to patients. They then considered whether any of these events could have been detected by any one of 13 common QA measures.
They found that most checks were effective less than 50% of the time."Port films, one of the most effective measures in place, had a 53% detection efficiency, while pre-treatment IMRT QA had a detection efficiency close to 0%. EPID-dosimetry had a detection rate of 83%. In some cases, EPID-dosimetry would have detected errors which were introduced after the initial IMRT QA."
According to a report on the presentation, the researchers found that a combination of common QA measures is sufficient to detect 90% of potential incidents.
We will be reporting further on radiation therapy safety protocols, and specifically the use of checklists to improve quality and efficiency, and our upcoming national meetings. Click here to register.