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Selective de-implementation of routine in vivo dosimetry
Serena P H Mao1, Sarah Han-Oh1, Joseph Moore1
1Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
Journal of Applied Clinical Medical Physics
|March 6, 2023
Summary
Routine diode use in radiotherapy patient setup has been reduced by implementing a selective approach. This quality improvement project ensures diodes are used only when necessary for patient safety, optimizing resource allocation.
Area of Science:
- Medical Physics
- Radiation Oncology Quality Assurance
Background:
- Cone-beam computed tomography (CBCT) is now standard for patient localization, reducing the need for routine diode-based verification.
- Balancing resource allocation, efficiency, and safety is crucial when determining the necessity of diode use in radiotherapy.
Approach:
- A de-implementation quality improvement project was conducted to discontinue routine diode use in non-intensity modulated radiotherapy (IMRT) cases.
- Recommendations were developed based on safety reports, literature review, and stakeholder input to limit diode use to specific scenarios.
- Diode use patterns were analyzed before and after policy implementation across five clinical sites.
Key Points:
- Diode use decreased from 32% to 13.2% overall after policy implementation.
- Use of diodes in 3D conformal photon fields without CBCT dropped significantly (23.2% to 4%).
- Diode utilization was maintained for critical scenarios: total body irradiation (TBI), electron beams, and cases with cardiac devices near the treatment field.
Conclusions:
- A selective approach to diode use in radiotherapy has been successfully implemented, prioritizing patient safety and optimizing resource allocation.
- De-implementation of routine diode use streamlined patient care and reduced costs without compromising safety.
- Tailored selection of diode use scenarios enhances standard quality assurance processes.
