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Medical physics external beam plan review: What contributes to the variability?
Greg Salomons1, Keith Nakonechny2, Cathy Neath3
1Cancer Center of Southeastern Ontario, 25 King Street West, Kingston, Ontario K7L 5P9, Canada.
Summary
Physics plan review practices vary significantly within and between cancer centers. Standardized checklists did not reduce variability, highlighting the need to consider local factors and follow guideline development best practices for effective implementation.
Area of Science:
- Medical Physics
- Radiation Oncology
- Healthcare Quality Improvement
Background:
- Physics plan review is crucial for radiation therapy quality assurance.
- Variations in practice can impact treatment consistency and patient outcomes.
- Understanding these variations is key to optimizing radiotherapy delivery.
Purpose of the Study:
- To survey and analyze physics plan review practices across Ontario cancer centers.
- To identify factors contributing to variations in practice within and between centers.
- To assess the impact of center characteristics on adherence to established guidelines.
Main Methods:
- A survey was conducted among medical physicists in various cancer centers.
- Intra-center variation and variation between centers were quantified using a 4-point Likert scale.
- Metrics were correlated with center characteristics, including vendor products, checklist usage, and workload.
Main Results:
- Bolus and heterogeneity corrections were universally checked; image registration and DVH binning were less common.
- Centers using single-vendor products showed significant differences in inter-center variation.
- Official checklists correlated with higher intra-center variation, while workload did not impact checking consistency.
Conclusions:
- Center resources and local workflow significantly influence checking practices, impacting TG275 guideline implementation.
- Standardized checklists did not reduce variability, emphasizing the importance of adherence to checklist development guidelines (MPPG4).
- Future efforts should focus on tailored implementation strategies and robust checklist design to improve consistency.
