Quality and Safety in Radiotherapy: Learning the New Approaches in Task Group 100 and Beyond

Quality and Safety in Radiotherapy: Learning the New Approaches in Task Group 100 and Beyond is the proceedings of the 2013 Annual AAPM Summer School. Six medical physicists edited it with extensive backgrounds in the topic that were also active in the summer school program. An additional 15 highly qualified individuals contributed to the book. The book captures the focus and much of the detail of the summer school program, introducing concepts of a new paradigm for quality and safety in radiotherapy, which may be new to many readers. Due to the ever increasing complexity of radiotherapy and the great number of different computerized systems we now use, quality assurance methods relying only on device-specific tests may miss important error pathways. At the same time, they are inordinately time consuming. New paradigms for more holistic quality management based on human factors, process mapping, failure modes and effects analysis, and industrial engineering techniques are presented in this book. Because these are new concepts to many, both the rationale for and implementation of these ideas are discussed. Although one can hunt down publications on these topics, this book serves as a useful compendium of information to guide the reader, either directly, or by way of the hundreds of relevant references distributed throughout the book. This book is a valuable addition to the literature collection of anyone on the radiotherapy team, since each is responsible and dedicated to the quality and safety of every patient's treatment. Unlike most books, the topics in this one should be shared and discussed by the team. Since the new paradigm is moving away from a QA being the only physicist working on the linac after hours, a team-centered approach to defining just what quality management really means in one's radiotherapy department. (confusing here) The book consists of 9 chapters followed by 11 practical exercises based on the book's key concepts. The book comes with a CD containing the text of the book, supplemental tables, and color figures. There is a useful summary at the end of each chapter. The book begins with an introduction that includes perspectives on quality from the patient' s, physician' s, and physicist's viewpoint. It highlights the differences between current and more modern approaches to quality management. The second chapter discusses the role of human factors and safety culture. The third chapter dives into failures in radiotherapy administration that have been documented, how they came about, and what type of actions could minimize their occurrence or impact. It also introduces the Incident Learning methodology that is the basis for the AAPM/ASTRO sponsored national incident database, Radiation Oncology-Incident Learning System (ROILs), which is about to be implemented. Chapter 4 is a synopsis of AAM Task Group 100's risk management report which will be published in 2014. This chapter includes a discussion of process mapping, FMEA, and fault tree analysis. Chapter 5 offers a broad discussion of quality management in radiotherapy, including commissioning of equipment, audit tools, checklists, and an example based on a 90Y microsphere liver cancer treatment. Chapter 6 delves into incident learning more deeply. Chapter 7 is devoted to quality improvement methods taken from industry and applied to radiotherapy. The next chapter offers a discussion on implementation of training and quality assurance documentation relying on computer systems, as well as, managing changes that come with this new paradigm. The final chapter provides an illustration of the application of the concepts already discussed in the book with three clinical scenarios. These examples do well in bringing home the new, potentially overwhelming concepts of process mapping, FMEA, and fault tree analysis. The exercises at the end of the book are realistic and thought-provoking. The summer school proceedings this book is based on was tremendously successful. This book does a good job of capturing its content. Some of the material may seem too esoteric for direct application to the clinic, but the vast majority is written and framed around clinical examples. I found myself putting the book down at various points and thinking about how I could implement the concepts in my own department. We indeed are moving into a new era of quality management in radiotherapy and this book serves as a conceptual and practical guide for a successful implementation. Dr. Arthur Olch is Professor of Clinical Pediatrics and Radiation Oncology at the University of Southern California-Keck School of Medicine and is Chief of Physics at Children's Hospital of Los Angeles. Dr. Olch chairs the AAPM subcommittee on Quality Assurance and Outcome Improvement, the AAPM Task Group 176 and he is a Fellow of the AAPM.