A. Anderson1, C. M. Colbert1, V. Bry1, K. Graef2, J. P. C. Cabahug3,4, A. Saravana Kumar5, B. Li1,6, L. E. Fong de los Santos7, E. C. Ford8, and A. A. Yorke1; 1Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA, 2BIO Ventures for Global Health, Seattle, WA, 3Health Physics Research Section, Atomic Research Division (ARD-HPRS), DOST-PNRI, Quezon City, Philippines, 4Radiation Research Center (RRC), Philippine Nuclear Research Institute, Department of Science and Technology (DOST-PNRI), Quezon City, Philippines, 5PSG Institute of Medical Sciences and Research & Hospitals, Coimbatore, India, 6Rayos Contra Cancer, Seattle, WA, 7Mayo Clinic, Rochester, MN, United States, 8University of Washington School of Medicine, Fred Hutch Cancer Center, Department of Radiation Oncology, Seattle, WA
Purpose/Objective(s): To describe the use of teletherapy QA capacity, QA protocols, and patient safety incident reporting systems in LMICs. Materials/
Methods: An electronic survey on QA practices was distributed to 220 medical physicists (MP) in 22 LMICs by contacts and the non-profit BIO Ventures for Global Health. Answers from each clinic’s most experienced respondent were summarized with descriptive statistics. The Teletherapy QA Capacity (TQC), defined as the ratio of the number of QA devices/tests (Array detector, film, EPID, ion chamber, solid water phantom, water tank, diode, TBI/TSET phantom, front pointer, Winston-Lutz, graph paper, ruler, laser localization, optical, and/or collimator indicator) to the number of machines, was calculated for each clinic. Results: Surveys were initiated by 119 MP and completed by 67 MP (34% response rate) from 50 clinics in 16 countries (76% represented). Of the 50 MP responses analyzed, 58% worked in government/academic settings, and 6% were trainees. QA devices/tests used in =70% of clinics included film, EPID, ion chambers, solid water phantoms, water tanks, rulers, and laser, optical and collimator checks. The mean number of QA devices/tests used per clinic was 10 (range 4-14). The mean number of teletherapy units per clinic was 1.7 (range 1-5). The mean clinic TQC was 7.4 (range 1.3-14). Local QA protocols were used in 24%/38% of clinics/ countries, and AAPM or IAEA protocols were used in 94%/94%, respectively. One clinic had no protocols. Safety incidents were documented in a clinic-wide system in 82%/81% of clinics/countries, hospital-wide system in 52%/69%, and the IAEA Safety in Radiation Oncology (SAFRON) database in 26%/44%, respectively. Conclusion: The TQC value is a novel, simple method to relate strengths and gaps in the treatment triad of teletherapy capacity, QA capacity, and patient outcomes. Most surveyed MP follow international QA guidelines and document safety incidents; feasibility and fidelity should be investigated further.
