A real-time audit of radiation therapy in a Regional Cancer Center

Purpose: 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 and Materials: Radiotherapy treatment plans were audited by a real- time peer-review process over an 8-year period (1989-1996). The overall goa l of the audit was to establish a process for quality assurance (QA) of rad iotherapy planning and prescription for individual patients. A parallel pro cess was developed to audit the implementation of intervention-specific rad iotherapy 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 plannin g. The majority of the nonapproved plans (79%) were modified prior to initi ating treatment; the audit provided important clinical feedback about indiv idual patient care in these instances, Most of the remaining nonapproved pl ans were deviations from normal practice due to patient-specific considerat ions. A further 110 (3.6% of all audited plans) were not approved by the au dit due to deviations from radiotherapy treatment policy. A minority of the se plans (22%) were modified prior to initiating treatment and the remainde r provided important feedback for continuous quality improvement of treatme nt policies. Conclusion: A real-time audit of radiotherapy practice in a regional cancer center setting proved feasible and provided important direct and indirect patient benefits. (C) 1998 Elsevier Science Inc.