Towards Safer Radiotherapy

The audit process should ideally:
• Be carried out by auditors who are independent of those whose procedures are being
audited
• Provide an opportunity for multidisciplinary co-operation and for cross-disciplinary
appreciation of all the tasks that comprise the overall process
• Be thorough and challenging but not prescriptive.
If problems are identified, a review of the process and, if required, remedial action should be
agreed by the auditor and department.
4.3.10 Multidisciplinary review of procedures especially when they are to be modified is essential.
For example, a modification in a pretreatment procedure such as change from conventional
to CT simulation might require new data (or at least review of the old data) from the medical
physics team and also changes in working practices for clinical oncologists and therapeutic
radiographers.
4.3.11 Audit in the context of quality management systems is usually considered at two levels:
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• Internal audit carried out within the radiotherapy organisation
• External audit, by an appropriate inspection body, necessary to achieve and maintain
external registration.
External and therefore independent registration is not a prescriptive requirement of the
Bleehen Report 40 but it is recognised as being beneficial in terms of public confidence and
provides an incentive to maintain the quality system which is somewhat onerous. A further
benefit of registration is that it can be used to promote radiotherapy as a generally safe
medical intervention.
4.3.12 Comparative audits between departments can provide valuable opportunities to ensure safe
delivery of radiotherapy and consistency of patient outcomes. Examples include:
• Audits based on the peer-review process designed to assess centres against the cancer
standards 61
• Audits with the initial purpose of testing the dissemination of dosimetry standards from
the National Physical Laboratory (NPL) to individual centres. These were introduced by
IPEM (previously the Institute of Physical Sciences in Medicine) in the early 1990s and are
organised on informal, geographically based networks with the support of the NPL.
As these dosimetric audits have developed, some networks have extended the purpose to
include an in-depth audit of specific clinical techniques.
• Quality assurance for clinical trials has ensured consistency between those centres
participating. This has led to substantial changes in practice in both prostate cancer with
the RT01 trial 62 and in breast cancer with the Standardisation of Breast Radiotherapy
(START) trials. 63
• In addition, national audits of radiotherapy practice have been shown to improve
treatment delivery. For example, an audit to assess interruptions to radical radiotherapy
in head and neck cancer has been undertaken. 64 This demonstrated that compliance
with the agreed standards was best when there was a formal departmental protocol. A
repeat audit has shown improvement. 65
Towards Safer Radiotherapy