From compliance to measurable safety: Multisite benchmarking of radioprotection performance in private radiotherapy...

Radiotherapy delivers intentional high-dose exposures with narrow therapeutic margins; therefore, radioprotection must function as a measurable safety system spanning governance, engineered controls, occupational monitoring, and patient safety barriers. Multicentre key performance indicator (KPI)-based benchmarking remains limited in Morocco, particularly within the private sector.

We conducted a cross-sectional, multisite benchmarking study across ten private radiotherapy centres in Morocco. A structured radioprotection framework was developed using a systems-based, risk-informed approach aligned with international safety and modern radiotherapy quality management principles. Centre-level KPIs were defined a priori in a data dictionary (unit, reference period, evidence sources) and collected via a standardised questionnaire supported by documentary verification. KPIs covered governance and training, occupational protection, incident learning and improvement systems, patient safety barriers and verification steps, machine and patient-specific quality assurance (QA), and high-dose-rate (HDR) brachytherapy preparedness (where applicable). Descriptive statistics were reported as medians, interquartile ranges, and ranges.

Governance maturity was variable: 80% of centres reported a designated Radiation Protection Officer (RPO) and 70% a documented radiation protection (RP) programme/local rules; 30% reported an International Organization for Standardization (ISO)-certified or otherwise accredited quality management system (QMS) and 20% had conducted a safety-culture survey within the last two years. Training coverage was moderate-to-high (median 82.5%) with induction within 30 days at 77.5%. Patient time-out checklists were universal (100%), while pretreatment plan/chart review and second contour checks were reported by 60% each; in-vivo dosimetry availability was limited (30%). Independent monitor unit (MU)/dose check coverage was high (median 97.5%), whereas patient-specific QA coverage and machine QA adherence showed wider dispersion (medians 87.5% and 82.5%, respectively). Incident learning remained heterogeneous: a formal reporting system was present in 60%, with median 9.5 reports/year and high near-miss share (median 62.5%); root-cause analysis (RCA) completion and corrective and preventive action (CAPA) timeliness varied (median 65% and 65 days). Occupational dosimetry compliance was generally high (median 93.5%), with higher mean effective dose in radiotherapy technologists (RTTs) than physicists and radiation oncologists.

KPI benchmarking across ten private Moroccan centres identified strong frontline safety practices (time-out, MU checks, high dosimetry compliance) alongside gaps in structured governance maturity (accredited QMS, safety culture measurement), incident learning capability, and selected high-reliability QA barriers. These findings support targeted, data-driven improvement plans that are practical for RTT-led implementation and compatible with evolving national safety expectations.

Radiotherapy must follow strict safety measures because it uses high doses of radiation to treat cancer. This study reviewed safety practices at ten private radiotherapy centres in Morocco using a standard set of quality and safety measures. This study found that routine safety checks and staff radiation monitoring were generally strong, but some centres had fewer systems for quality management, incident learning, and quality assurance. This matters because improving these areas can help make cancer treatment safer for patients and staff.