Three years experience in the development of a dynamic quality management concept in a digitized radiotherapy department.
BACKGROUND
This article addresses general procedures for dynamic quality management and offers some practical suggestions to control an electronic radiotherapy system. The review of data takes place additionally to and completely independent of visual opportunities such as the approval of port images.


METHODS
The radiotherapy procedure was split up into individual processes, all steps were analyzed with respect to their potential of being influenced by human mistakes or system malfunction.


RESULTS
Relating the mistakes to the absolute number of treated fields, we can show that the percentage of fields that is related to an error was 0.22% in 1997 and could be decreased to 0.18% in 1999. For an average number of about 90-100 patients per day the time to verify the electronic data were: 6-8 h for the routine weekly control, 4 h/week to check the first treatments and manually calculated treatment fields, 6 h/week for physicists to check the 3D plans and 12 h/week for senior oncologists to check the 3D plans and data approval in the verification system.


CONCLUSIONS
Meticulous monitoring and the currently available level of automation ensure that even clinically irrelevant errors and mistakes can be detected so that patients can be offered patient-oriented efficient radiotherapy in a routine hospital setting.
Mitterer
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Institut für Radioonkologie, Kaiser-Franz-Josef-Spital, Wien, Austria. sabine.mitterer@kfj.magwien.gv.at
Schratter-Sehn
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D001317:Austria; D006748:Hospital Departments; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011880:Radiotherapy Planning, Computer-Assisted; D013996:Time and Motion Studies; D017749:Total Quality Management