Consensus Building for Radiotherapy Quality Assurance: A Multicenter Methodological Narrative From India...

The incidence of cancer is rising in India, and radiotherapy plays a vital role in the management of most cancers. More radiotherapy centers are being set up across the country to cater to this need. Quality assurance (QA) of radiotherapy is crucial to minimize risks and ensure best outcomes for all patients receiving radiotherapy. We outline an effort to develop a standardized radiotherapy QA program implementable across India through a consensus process among stakeholders.

The team structured a Standardised Unified Radiotherapy QA model (SURAQSA), a program of pan-India radiotherapy QA incorporating elements of radiotherapy trials QA, adapted for the Indian health care system. Engagement of a cross-section of radiation oncologists working across India to achieve consensus on the issue was essential. This paper describes the consensus development process among the diverse Indian centers/professionals in support of the SURAQSA program. The statement was introduced to clinicians through the vehicle of an abbreviated Delphi consensus process, with guidance from the Royal College of Radiologists (United Kingdom). We outline the elements of the SURAQSA program and describe the consensus adopted.

Thirteen centers from across India were represented in the workshop. Three of the consensus statements on external QA of each center, prospective peer review of contours, plan quality measures, and protocol-driven management, as the basic requirements received unanimous support. Consensus was also achieved on the pilot subsite for this exercise with minor disagreement.

This report showed feasibility of a wide stakeholder engagement to deliver focused outputs and is a huge step toward formulating site-specific radiotherapy QA programs. The process allowed oncologists to highlight the need to take essential steps for radiotherapy safety across centers with varying availability of trained manpower and infrastructure.