Emerging Canadian QA standards for radiation therapy

Full text: Canada operates a publicly funded health care system in which 70% of health care costs are paid by some level of government. Radiotherapy, indeed most cancer management, falls within the publicly funded realm of Canada's health care system. National legislation (the Canada Health Act) guarantees access to cancer services for all Canadians. However, the financial responsibility for these services is borne by the provinces. Most Canadian provinces manage the cancer management problem through central cancer agencies. In the past few decades, these provincial cancer agencies have formed the Canadian Association of Provincial Cancer Agencies (CAPCA). This association has adopted a broad mandate for cancer management in Canada (see www.capca.ca). Included in this mandate is the adoption of standards and guidelines for all aspects of cancer control. The complexity of radiation therapy has long underscored the need for cooperation at the international and national levels in defining programmes and standards. In recent decades formal quality assurance programme recommendations have emerged in the United States, Europe and Great Britain. When defining quality assurance programs, Canadian radiation treatment centres have referenced U.S. and other program standards since they have been available. Recently, under the leadership of the Canadian Association of Provincial Cancer Agencies (CAPCA), Canadian national quality assurance program recommendations are emerging. A CAPCA sponsored project to harmonize Canadian quality assurance processes has resulted in a draft document entitled 'Standards for Quality Assurance at Canadian Radiation Treatment Centres'. This document provides recommendations for the broad framework of radiation therapy quality assurance programs. In addition, detailed work is currently underway regarding equipment quality control procedures. This paper explores the historical and political landscape in which the quality assurance problem has evolved in Canada, summarizes progress to date and examines future opportunities for Canadian quality assurance standardization. (author)