Structural Quality Indicators in Radiation Oncology: Insights and Implications

Over the past two decades, significant progress has been made in the development of quality indicators (QIs) within the field of radiotherapy (RT). However, most of the literature has predominantly focused on process and outcome-related QIs, with limited attention given to structural QIs. This review aims to address this gap by providing insights into structural QIs in RT and examining the complexities and considerations involved in establishing universal standards for these indicators across RT facilities globally.

An extensive review of published evidence in each sub-topic was performed using PubMed search strategies, current review papers, national and international guidelines and reports, and personal expertise in the field.

Considering their direct impact on treatment outcomes, this article identifies five structural QIs to ensure quality treatment in RT. They are workload, infrastructure, machine downtime, adequacy of training, and access to RT services.

Developing international guidelines for structural QIs in RT can significantly enhance treatment outcomes. The first step toward achieving this goal is to assess the limitations faced by lower and middle-income countries (LMICs) and devise practical solutions to overcome these challenges.