Abstract：
BACKGROUND: The quality of radiotherapy delivery has been shown to significantly impact clinical outcomes including patient survival. To identify errors, institutions perform Patient Specific Quality Assurance (PSQA) assessing each individual radiotherapy plan prior to starting patient treatments. Externally administered Dosimetry Audits have found problems despite institutions passing their own PSQA. Hence a new audit concept which assesses the institution\'s ability to detect errors with their routine PSQA is needed.
METHODS: Purposefully introduced edits which simulated treatment delivery errors were embedded into radiation treatment plans of participating institutions. These were designed to produce clinically significant changes yet were mostly within treatment delivery specifications. Actual impact was centrally assessed for each plan. Institutions performed PSQA on each plan, without knowing which contained errors.
RESULTS: Seventeen institutions using six radiation treatment planning systems and two delivery systems performed PSQA on twelve plans each. Seventeen erroneous plans (across seven institutions) passed PSQA despite causing >5% increase in spinal cord dose relative to the original plans. Six plans (from four institutions) passed despite a >10% increase.
CONCLUSIONS: This novel audit concept evolves beyond testing an institution\'s ability to deliver a single test case, to increasing the number of errors caught by institutions themselves, thus increasing quality of radiation therapy and impacting every patient treated. Administered remotely this audit also provides advantages in cost, environmental impact, and logistics.
METHODS: Purposefully introduced edits which simulated treatment delivery errors were embedded into radiation treatment plans of participating institutions. These were designed to produce clinically significant changes yet were mostly within treatment delivery specifications. Actual impact was centrally assessed for each plan. Institutions performed PSQA on each plan, without knowing which contained errors.
RESULTS: Seventeen institutions using six radiation treatment planning systems and two delivery systems performed PSQA on twelve plans each. Seventeen erroneous plans (across seven institutions) passed PSQA despite causing >5% increase in spinal cord dose relative to the original plans. Six plans (from four institutions) passed despite a >10% increase.
CONCLUSIONS: This novel audit concept evolves beyond testing an institution\'s ability to deliver a single test case, to increasing the number of errors caught by institutions themselves, thus increasing quality of radiation therapy and impacting every patient treated. Administered remotely this audit also provides advantages in cost, environmental impact, and logistics.
摘要：
放射治疗的质量已被证明显著影响包括患者生存在内的临床结果。要识别错误，在开始患者治疗之前,各机构执行患者特定质量保证(PSQA)评估每个单独的放疗计划.尽管机构通过了自己的PSQA，但外部管理的剂量学审核却发现了问题。因此，需要一种新的审计概念，该概念评估机构使用其常规PSQA检测错误的能力。
有目的地引入了将模拟治疗交付错误嵌入参与机构的放射治疗计划中的编辑。这些被设计为产生临床上显著的变化,但大多在治疗递送规范内。对每个计划的实际影响进行了集中评估。机构对每个计划执行PSQA，不知道哪些包含错误。
使用六个放射治疗计划系统和两个交付系统的17个机构分别对12个计划进行了PSQA。尽管相对于原始计划导致脊髓剂量增加>5％，但17个错误计划（跨7个机构）通过了PSQA。尽管增长超过10%，但六个计划(来自四个机构)获得通过。
这种新颖的审计概念超越了测试机构提供单个测试用例的能力，增加机构自己发现的错误数量，从而提高放射治疗的质量，并影响每一位接受治疗的患者。远程管理此审核还提供了成本优势，环境影响,和物流。
有目的地引入了将模拟治疗交付错误嵌入参与机构的放射治疗计划中的编辑。这些被设计为产生临床上显著的变化,但大多在治疗递送规范内。对每个计划的实际影响进行了集中评估。机构对每个计划执行PSQA，不知道哪些包含错误。
使用六个放射治疗计划系统和两个交付系统的17个机构分别对12个计划进行了PSQA。尽管相对于原始计划导致脊髓剂量增加>5％，但17个错误计划（跨7个机构）通过了PSQA。尽管增长超过10%，但六个计划(来自四个机构)获得通过。
这种新颖的审计概念超越了测试机构提供单个测试用例的能力，增加机构自己发现的错误数量，从而提高放射治疗的质量，并影响每一位接受治疗的患者。远程管理此审核还提供了成本优势，环境影响,和物流。
