Towards Safer Radiotherapy

tendering process in which the radiotherapy department specifies a series of requirements
against which potential suppliers offer their products.
Consideration with respect to safety should include:
• Compatibility with other equipment to enable easy transfer of patients between
machines
• Ease of connection with existing equipment
• Training requirements; for example, many different types of machine will require specific
training
• Appropriateness to meet clinical needs.
Recommendation
The criteria used in the evaluation of equipment with the procurement process should
include a review of both the positive and negative implications of performance specifications
for patient and staff safety.
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4.4.2 Commissioning of radiotherapy equipment
The commissioning of radiotherapy equipment prior to clinical use is critical to its future safe
operation. It is at this point when specific work instructions are developed and data that will
be used during its operation (for example, for treatment planning) are collected and
processed. Any errors that are introduced at this stage and not detected will potentially
affect all patients for whom the equipment is used.
The commissioning process for linear accelerators is discussed in depth in Acceptance Testing
and Commissioning of Linear Accelerators 68 by IPEM and while this is specific to one class of
radiotherapy equipment, the same principles can be applied to other machines and software,
such as simulators, including CT simulators, and treatment planning systems.
In addition to the individual items of equipment, radiotherapy centres have become
increasingly dependent on information technology and electronic communication. This is an
inevitable consequence of the introduction of computer-controlled devices, such as multi-leaf
collimators. Manual transcription of such a large quantity of data is impractical and if
attempted would be error prone.
Indeed, there is abundant evidence that error rates have been significantly reduced after the
implementation of electronic transfer of data between planning systems and treatment
machines. 69,70 However, because electronic transfer is accepted as being highly reliable, it is
extremely important to ensure that any electronic links including networks are rigorously
tested as they are established. The IPEM report 93 Guidance for the Commissioning and
Quality Assurance of a Networked Radiotherapy Department 71 provides detailed and specific
guidance on this topic. Failure to identify incompatibilities between data structures across a
networked facility would embed errors which, particularly for data items that are perhaps
accessed infrequently, could be the source of error for the life of the network.
Towards Safer Radiotherapy