Errors in radiotherapy: motivation for development of new radiotherapy quality assurance paradigms

Modern radiotherapy practice has rapidly evolved during the past decade, making use of many highly complex and/or automated processes for planning and delivery, including new techniques, like intensity-modulated radiotherapy driven by inverse planning optimization methods, or near real-time image-guided adaptive therapy based on fluoroscopic or tomographic imaging on the treatment machine. In spite of the modern technology, or potentially because of it in some instances, errors and other problems continue to have a significant impact on the field. This report reviews example errors and problems, discusses some of the quality assurance issues that these types of problems raise, and motivates the development of more modern and sophisticated approaches to assure quality for our clinical radiotherapy treatment methods.