Towards Safer Radiotherapy

Recommendation
Multidisciplinary working with clear communication is essential for a safe radiotherapy
department and such a culture should be actively developed. Questioning irrespective of
position within the organisation should be actively encouraged. Those reporting
uncertainties and errors should be given due credit for professional behaviour.
4.3 Systems
4.3.1 Radiotherapy treatment may be delivered by external beam radiotherapy, or via the
application of sealed radioactive sources (brachytherapy), or through a combination of the
two. For treatments to be delivered as intended, tasks have to be correctly executed
according to well-defined protocols as part of the QART system.
The need for procedures to be documented, audited and continually reviewed has been
recognised and a framework based on the International Standard ISO9001:2000 (formerly
BS5750 / ISO 9000) 60 was recommended by the Bleehen report Quality Assurance in
Radiotherapy. 40
A requirement for each radiotherapy department to have documented quality systems has
subsequently been included in the English Department of Health’s Manual of Cancer Services
2004. 61 The QART system should cover all radiotherapy processes, from the time of the
decision to treat the patient, up to the first outpatient follow-up appointment and include
radiation therapy equipment quality control.
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To function properly and remain up to date, the QART system requires the commitment and
financial support of the management of the healthcare organisation.
Recommendation
Each department should have a fully funded, externally accredited quality management
(QART) system in place.
4.3.2 The underlying objectives of a QART system are:
• To deliver radiotherapy treatment as intended by the prescriber and in accordance with
departmental protocols
• To continually improve the quality of treatment delivery by reviewing non-conformances
• To involve all staff in learning from incidents, errors and near misses.
4.3.3 To achieve these objectives, all routine procedures should be carried out in accordance with
documented and approved management protocols and all non-routine work that may affect
treatment outcome is to be approved through a system of written ‘concessions’. The
management protocols, management structure and organisational charts should be subject
to continual review (at a minimum every two years), and changes introduced wherever and
whenever appropriate to improve the effectiveness and efficiency of the radiotherapy
department.
Towards Safer Radiotherapy