A real-time audit of radiation therapy in a regional cancer center.
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.
Brundage
M D
MD
Radiation Oncology Research Unit, Kingston Regional Cancer Center, Kingston General Hospital, Ontario, Canada.
Dixon
P F
PF
Mackillop
W J
WJ
Shelley
W E
WE
Hayter
C R
CR
Paszat
L F
LF
Youssef
Y M
YM
Robins
J M
JM
McNamee
A
A
Cornell
A
A
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*