title: A real-time audit of radiation therapy in a regional cancer center.
abstract: OBJECTIVE
  To report the development, structure, and implementation of a real-time clinical radiotherapy audit of the practice of radiation oncology in a regional cancer center.
  
  
  METHODS
  Radiotherapy treatment plans were audited by a real-time peer-review process over an 8-year period (1989-1996). The overall goal of the audit was to establish a process for quality assurance (QA) of radiotherapy planning and prescription for individual patients. A parallel process was developed to audit the implementation of intervention-specific radiotherapy treatment policies.
  
  
  RESULTS
  A total of 3052 treatment plans were audited. Of these, 124 (4.1%) were not approved by the audit due to apparent errors in radiation planning. The majority of the nonapproved plans (79%) were modified prior to initiating treatment; the audit provided important clinical feedback about individual patient care in these instances. Most of the remaining nonapproved plans were deviations from normal practice due to patient-specific considerations. A further 110 (3.6% of all audited plans) were not approved by the audit due to deviations from radiotherapy treatment policy. A minority of these plans (22%) were modified prior to initiating treatment and the remainder provided important feedback for continuous quality improvement of treatment policies.
  
  
  CONCLUSIONS
  A real-time audit of radiotherapy practice in a regional cancer center setting proved feasible and provided important direct and indirect patient benefits.
authors.affiliation: Radiation Oncology Research Unit, Kingston Regional Cancer Center, Kingston General Hospital, Ontario, Canada.
authors.forename: M D
authors.initials: MD
authors.lastname: Brundage
authors.forename: P F
authors.initials: PF
authors.lastname: Dixon
authors.forename: W J
authors.initials: WJ
authors.lastname: Mackillop
authors.forename: W E
authors.initials: WE
authors.lastname: Shelley
authors.forename: C R
authors.initials: CR
authors.lastname: Hayter
authors.forename: L F
authors.initials: LF
authors.lastname: Paszat
authors.forename: Y M
authors.initials: YM
authors.lastname: Youssef
authors.forename: J M
authors.initials: JM
authors.lastname: Robins
authors.forename: A
authors.initials: A
authors.lastname: McNamee
authors.forename: A
authors.initials: A
authors.lastname: Cornell
mesh_terms: D002170:Canada; D002173:Cancer Care Facilities / Q000592:standards*; D006801:Humans; D008485:Medical Audit / Q000592:standards*; D016134:Organizational Policy; D016730:Program Development; D018787:Radiation Oncology / Q000592:standards*; D011878:Radiotherapy / Q000592:standards*