Comprehensive audits of radiotherapy practices: A tool for quality improvement: Quality Assurance Team for Radiation Oncology (QUATRO)

As part of a comprehensive approach to quality assurance (QA) in the treatment of cancer by radiation, an independent external audit (peer review) is important to ensure adequate quality of practice and delivery of treatment. Quality audits can be of various types and at various levels, either reviewing critical parts of the radiotherapy process (partial audits) or assessing the whole process (comprehensive audits). The IAEA has a long history of providing assistance for dosimetry (partial) audits in radiotherapy to its Member States. Together with the World Health Organization (WHO), it has operated postal audit programmes using thermoluminescence dosimetry (TLD) to verify the calibration of radiotherapy beams since 1969. Furthermore, it has developed a set of procedures for experts undertaking missions to radiotherapy hospitals in Member States for on-site review of dosimetry equipment, data and techniques, measurements and training of local staff. This methodology involves dosimetry and medical radiation physics aspects of the radiotherapy process without entering into clinical areas. The IAEA, through its technical cooperation programme, has received numerous requests from developing countries to perform comprehensive audits of radiotherapy programmes to assess the whole process. including aspects such as organization, infrastructure, and clinical and medical physics components. The objective of a comprehensive clinical audit is to review and evaluate thc quality of all of the components of the practice of radiotherapy at an institution, including its professional competence, with a view to quality improvement. A multidisciplinary team, comprising a radiation oncologist, a medical physicist and a radiotherapy technologist, carries out the audit. The present publication has been field tested by IAEA teams performing audits in radiotherapy programmes in hospitals in Africa, Asia, Europe and Latin America. Their comments, corrections and feedback have been taken into account, as well as the suggestions of the participants of the IAEA workshop Quality Assurance Team for Radiation Oncology (QUATRO), held in Vienna in May 2005. The QUATRO procedures have been endorsed by the European Federation of Organisations for Medical Physics, the European Society for Therapeutic Radiology and Oncology, and the International Organization for Medical Physics