Accreditation Is Coming

Accreditation Is Coming

Accreditation Is Coming

Accreditation Is Coming

Yes, It Is!

Currently, Accreditation is Voluntary

However, Some of the Accrediting Organizations Are Lobbying the Congress to Adopt a

Resolution to Make Accreditation Mandatory VA Radiation Oncology Facilities Have Already Adopted the ACR Accreditation.

Description and Requirements of

Radiation Therapy Accreditation

Programs: The Role of The

Dosimetrist

Mehdy Jabir, M.Phil., DABR, BABSNM Dade Moeller & Associates

Gaithersburg, MD 443-608-9116

Disclosures

• ACR Member • ACRO Member

• Work for a Service Provider Company-

Consultative Surveys,…

• Participate in ACR and ACRO Programs

• Showing Any Device or Software Represents NO ENDORSEMENT

Accrediting Organizations:

•

American College of Radiology ACR

•

American College of Radiation Oncology

ACRO

Accreditation,

IT IS ALL ABOUT SAFETY, YOUR SAFETY, MY SAFETY AND PATIENTS’ SAFETY.

Benefits of Accreditation as per TJC:

• Helps organize and strengthen patient safety

efforts — Patient safety and quality of care issues

are at the forefront of Joint Commission standards and initiatives.

• Strengthens community confidence in the

quality and safety of care, treatment and services — Achieving accreditation makes a

strong statement to the community about an organization’s efforts to provide the highest

Objectives

• Accreditation Requirements • Reasons to Seek Accreditation • Roles of Various Staff Members

• The Objectives are very wide ; I am available

during this meeting for follow ups on the subject of Accreditation

• This is a practical approach to accreditation: requirements, path to pass, pitfalls, etc..

• I Shall Show You Some Cases That You May Want to Emulate or Avoid

• I Start With General Issues, and Then Go to Specifics

 ACRO: “Approximately 20% of all radiation

facilities in the US are ACRO accredited or are in the review process”. (ACR: Estimates 3000 Facilities in US, Only 10% Accredited).

 ACRO and ACR/ASTRO are evenly split.

 Over 40 applications for accreditation were received in June by ACRO, the largest number received in a month to date.

 Majority of ACRO Accreditation reports are given “Provisional status”.

Why Go Through Accreditation? • Educational

• Bring Other Professionals in the field to

Diagnose, Trouble Shoot and Improve Your Practice.

Consultative Survey

• Thorough Evaluation of the Center

• The Consultative Survey Is Followed by

Comprehensive And Detailed Report, With Conclusions And Recommendations.

• It Is Recommended That Physics And

Management Discuss The Findings Of This Report.

Application: The Process

• Apply on Line • Fees

• Enter Facility Personnel Information • Submit required Data

Application: The Process

• Examination of Submitted Materials • Onsite Survey

• Results: Pass, Deferred, Denied

• If Pass: Certificate….Valid for Three Years • If Deferred: Appeal

Application: The Process

1. Visit

www.acr.org/accreditation www.acro.org/accreditation

2. Read and get very knowledgeable of the Process and requirements before you apply. 3. Talk, Talk, Talk and Continue Talk

Who Are The Personnel responsible and directly involved in the accreditation process: EVERYONE • Therapists

• Radiation Oncologists • Physicists

• Radiation Safety Officers • Managers

• Nurses

• From the Start of the Accreditation Process,

Manpower

The Accreditation Is a Lengthy and Demanding Process, And Requires Extensive Manpower. And So As a Dosimetrist:

1. Know Your Role And Responsibilities in the Process

2. Assess How Advanced You Are in Achieving the Goals Assigned to You? Generate a Time Line

Application: Requirements 1:

• Personnel • Systems

• Quality Control

Application: Requirements 2:

1. Policies & Procedures

2. Guidelines to Safe Practice NRC Safety Culture

3. Physicist and Physician Peer-Review 4. QC/QA for All Systems

Survey/Visit

On the Day of the Survey:

Surveyors Conduct Meetings, interviews,

Visits, Verification of Documents, Check

Charts (Paper or EMR) ..

Staffing

“Staffing Per Number of New Patients Annually, 8 hour per day, five days per week.

• Radiation Oncologists . . . 1 per 200 – 300 • Medical Physicists . . . 1 per 200 – 300,

(25% IMRT)

• Dosimetrists. . . 1 per 300 - 350,

(25% IMRT)

• Nurses . . . 1 per 200 – 300 • Radiation Therapists. . . 1 per 100 – 150,

(Minimum of 2), (25% IMRT)

Personnel: Credentials

Board Certification requirements for: Oncologists

Therapists Physicists Nurses

CMD or No CMD?

As Per ACRO Manual:

“Medical dosimetrist: A Medical Dosimetrist should be certified by the Medical Dosimetrist Certification Board”

Physicist

Should Have Certification in Radiation Therapy by:

ABR ABMP CCPM

Radiation oncologist peer review

As Per ACRO:

At least ten percent (10%) of all cases

managed within a radiation oncology

practice must be examined via a physician

(Radiation Oncologist) peer review

mechanism.

Physics Peer-Review

• Should Be Detailed, And Examine:

 Routine Physics and Dosimetry Practices  All QC Records and Protocols

 Radiation Safety Program and Records  TPS QC Records

 _{Record & Verify System}  Imaging Systems QC

TPS

Treatment planning: The practice should

demonstrate the following:

• Access to a computerized treatment

planning system, on site or remote.

• Records of system commissioning,

acceptance testing and beam data.

• Concordance of beam data with British

Journal of Radiology – 25 data for 5x5cm,

10x10cm, 20x20cm and 30x30cm fields.

Annual TPS Evaluation

•

Annual TPS Performance Evaluation

Performed by Dosimetrist and Physicist

•

Most recent evaluation report should be

available during the survey

•

Deficiencies resolved and corrective

measures taken.

•

Commissioning of the Treatment

Planning System Should Not Be Confused

With QC of the Treatment Planning

System!

•

Documentation of Full Commissioning of

TPS Should Be Available for Review!

R&V

As Per ACRO, For The Record and verify systems: The

practice should demonstrate the following when applicable:

• Records of acceptance testing and commissioning of the record and verify system.

• Backup records, either computerized or hard copy.

• Computer system security.

Verification of monitor unit calculations for non-IMRT clinical radiotherapy: Report of AAPM Task Group 114

The requirement of an independent verification of the monitor units MU or time calculated to deliver the prescribed dose to a patienthas

been a mainstay of radiation oncology quality assurance.

The need for and value of such a verification was obvious when calculations were performed by hand using look-up tables, and the verification was achieved by a second person independently repeating

the calculation. However, in a modern clinic using CT/MR/PET simulation, computerized 3D treatment planning, heterogeneity corrections, and complex calculation algorithms such as

convolution/superposition and Monte Carlo, the purpose of and methodology for the MU verification have come into question. In addition, since the verification is often performed using a simpler

geometrical model and calculation algorithm than the primary calculation, exact or almost exact

agreement between the two can no longer be expected. Guidelines are needed to help the physicist set clinically reasonable action levels for agreement. This report addresses the following charges of the task group: 1 To re-evaluate the purpose and methods of the “independent second check” for monitor unit calculations for non-IMRT radiation treatment in light of the complexities of modern day treatment planning. 2 To present recommendations on how to perform verification of monitor unit calculations in a modern clinic. 3 To provide recommendations on establishing action levels for agreement between primary calculations and verification, and to provide guidance in addressing discrepancies outside the

NOTE:

The Second Check Should Be

Independent And Effective

CME

11. Education Program: Continuing

medical education (CME) programs are

required for physicians, physicists,

dosimetrists, nurses, and radiation therapy

technology staff.

This Program Should Adhere to Local

BJR Data

Energy:

FS/cm

Source

Clin BJR % dif Clin BJR % dif Clin BJR % dif Clin BJR % dif

d=5cm

0.904 0.919 0.984 0.923 0.928 0.995 0.935 0.939 0.996 0.941 0.945 0.996

d=10cm

0.740 0.745 0.993 0.779 0.786 0.991 0.814 0.820 0.993 0.832 0.837 0.994

d=20cm

0.482 0.484 0.996 0.527 0.532 0.991 0.582 0.587 0.991 0.616 0.620 0.994

5x5

10x10

20x20

30x30

6 MV TMR

EPID QC

•

See TG-142 for Required Tests and

Frequencies

•

Commercial Software and Devices Are

Available. Which One to Choose?

•

Test: Spatial Resolution, Uniformity,

Linearity, Spatial Distortion,

Safety And Security Of Radioactive Sources

Such As Ir-192, Cs-137,.. Should be Maintained.

It Is Not Only External Beam

HDR P&P

HDR Treatment- Policies And Procedures: • Should be Documented

• Clear, Explicit And Easy To Follow

Patient Radiation Survey

A Few Questions That May Help Pass

The Accreditation Survey: #1

• Are Your OBI,CBCT and EPID Tests Performed As Per the Guidelines Of TG-142? And At The Frequency Required?

• Do Your IMRT Plans Meet Target Coverage and Critical Structures Sparing Objectives?

• Are SSDs Checked And Documented on Regular Basis?

• Do You Use The Appropriate Grid Resolution For all Plans?

A Few Questions

: #2

• Do You Perform The TPS Backups on Daily

Basis, To Avoid Possible Loss of Patient Data? • Do Your Patient Specific IMRT Plans meet the

3%, 3mm Gamma Criteria?

• Do You Radiologically Verify The Diameter of Cylinders Used In HDR for Every Fraction?

• Do Physics and Dosimetry Communicate and Consult Continuously and Effectively?

End-to-End Performance

E2E

The test involves every step in the SRS process, including:

• MRI scan • CT scan

• Target contouring on MRI scan • MRI/CT image fusion

• Treatment planning

• Localization with either head frame or image guidance

What is an End-to-End Testing?

An end-to-end testing is method that tests the entire process from beginning to end in a real environment, which includes imaging system, software, operators, planning system, set up by therapists, delivery system,...

With this test, you can check a complete

application in an environment of man/machine interaction; as most of these tests are manual in nature.

Safety Culture

See The NRC Website on Safety Culture And Correlate With Accreditation Requirements. Accreditation Promotes Safety.

Radiation Safety Committee

• Do You Have A RSC

• Composition of the RSC, and Attendance • Who Chairs the RSC?

• Frequency of the RSC Meetings • Minutes of Meetings

I encourage you to read the AAPM

reports

• TG 51 on Output Measurements – A must for accreditation

• TG 119 on TPS QA

• TG 114 on MU Calculations

• TG 142 on QA for Medical accelerators • TG 120 on IMRT QA

Accreditation should not be for marketing. Really?

!

• Be There,

• Get Engaged and • Feel The Process