title: Quality indicators in the intensity modulated/image-guided radiotherapy era.
abstract: OBJECTIVE
  To propose new Quality Indicators (QIs) for the Intensity Modulated(IMRT)/Image-Guided(IGRT) Radiotherapy techniques.
  
  
  METHODS
  Two structure, 10 process and 2 outcome QIs were elaborated. A working group including Radiation Oncologist, Medical Physicist and Radiation Technologists was made up. A preliminary set of indicators was selected on the basis of evidenced critical issues; the criteria to identify more relevant and specific QIs for IMRT/IGRT were defined; structure, process and outcome QIs were defined. The elaborated indicators were tested in four Italian Radiotherapy Centers.
  
  
  RESULTS
  Fourteen indicators were proposed. Seven indicators were completely new while a new standard is proposed for four indicators based on Validation Centers (VC) data. No change was reported for 3 indicators. The indicators were applied in the four VC. The VC considered were able to respect all indicators except indicator 2 for one Center.
  
  
  CONCLUSIONS
  QIs may provide useful measures of workload and service performances.
authors.affiliation: Radiotherapy Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy. Electronic address: pietro.gabriele@ircc.it.
authors.forename: P
authors.initials: P
authors.lastname: Gabriele
authors.affiliation: Medical Physics Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Maggio
authors.affiliation: Radiotherapy Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Garibaldi
authors.affiliation: Medical Physics Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bracco
authors.affiliation: Radiotherapy Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Delmastro
authors.affiliation: Radiotherapy Unit, Sassari University, Sassari, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Gabriele
authors.affiliation: Physics Technologies in Biomedicine Unit, National Institute of Health, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Rosi
authors.affiliation: Radiation Oncology, TomoTherapy Unit, Hospital of Aosta, Aosta, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Munoz
authors.affiliation: Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Di Muzio
authors.affiliation: IRCCS San Martino-IST and University,Genoa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Corvò
authors.affiliation: Medical Physics Department of the Candiolo Cancer Center-FPO-, IRCCS, Candiolo, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Stasi
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000000981:diagnostic imaging*; D061089:Radiotherapy, Image-Guided / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods
keywords: IMRT/IGRT; Quality assurance; Quality indicators