Wells, Michelle

AbstractBackgroundAAPM Task Group (TG) 275 was charged with developing practical, evidence‐based recommendations for physics plan and chart review clinical processes for radiation therapy. As part of this charge, and to characterize practices and clinical processes, a survey of the medical physics community was developed and conducted. Detailed analyses and trends based on the survey that exceeded TG report length constraints are presented herein.AimsThe design, development, and detailed results of the TG‐ 275 survey as well as statistical analysis and trends are described in detail. This is complementary material to the TG 275 report.Methods and materialsThe survey consisted of 100 multiple‐choice questions divided into four main sections: 1) Demographics, 2) Initial Plan Check, 3) On‐Treatment, and 4) End‐of‐Treatment Chart Check. The survey was released to all AAPM members who self‐reported working in the radiation oncology field, and it was kept open for 7 weeks. Results were summarized using descriptive statistics. To study practice differences, tests of association were performed using data grouped by four demographic questions: 1) Institution Type, 2) Average number of patients treated daily, 3) Radiation Oncology Electronic Medical Record, and 4) Perceived Culture of Safety.ResultsThe survey captured 1370 non‐duplicate entries from the United States and Canada. Differences across practices were grouped and presented based on Process‐Based and Check‐Specific questions. A risk‐based summary was created to show differences amongst the four demographic questions for checks associated with the highest risk failure modes identified by TG‐275.ConclusionThe TG‐275 survey captured a baseline of practices on initial plan, on‐treatment, and end‐of‐treatment checks across a wide variety of clinics and institutions. The results of test of association showed practice heterogeneities as a function of demographic characteristics. Survey data were successfully used to inform TG‐275 recommendations.

Background While the review of radiotherapy treatment plans and charts by a medical physicist is a key component of safe, high‐quality care, very few specific recommendations currently exist for this task. Aims The goal of TG‐275 is to provide practical, evidence‐based recommendations on physics plan and chart review for radiation therapy. While this report is aimed mainly at medical physicists, others may benefit including dosimetrists, radiation therapists, physicians and other professionals interested in quality management. Methods The scope of the report includes photon/electron external beam radiotherapy (EBRT), proton radiotherapy, as well as high‐dose rate (HDR) brachytherapy for gynecological applications (currently the highest volume brachytherapy service in most practices). The following review time points are considered: initial review prior to treatment, weekly review, and end‐of‐treatment review. The Task Group takes a risk‐informed approach to developing recommendations. A failure mode and effects analysis was performed to determine the highest‐risk aspects of each process. In the case of photon/electron EBRT, a survey of all American Association of Physicists in Medicine (AAPM) members was also conducted to determine current practices. A draft of this report was provided to the full AAPM membership for comment through a 3‐week open‐comment period, and the report was revised in response to these comments. Results The highest‐risk failure modes included 112 failure modes in photon/electron EBRT initial review, 55 in weekly and end‐of‐treatment review, 24 for initial review specific to proton therapy, and 48 in HDR brachytherapy. A 103‐question survey on current practices was released to all AAPM members who self‐reported as working in the radiation oncology field. The response rate was 33%. The survey data and risk data were used to inform recommendations. Discussion Tables of recommended checks are presented and recommendations for best practice are discussed. Suggestions to software vendors are also provided. Conclusions TG‐275 provides specific recommendations for physics plan and chart review which should enhance the safety and quality of care for patients receiving radiation treatments.