Quality and Safety Considerations in Image Guided Radiation Therapy: An ASTRO Safety White Paper Update

Abstract

This updated report on image guided radiation therapy (IGRT) is based on a consensus-based white paper previously published by the American Society for Radiation Oncology (ASTRO) addressing patient safety. In the past decade, IGRT technology and procedures have progressed significantly and are now more commonly used. The use of IGRT has now extended beyond high-precision treatments, such as stereotactic radiosurgery and stereotactic body radiation therapy, and into routine clinical practice for many treatment techniques and anatomic sites. Therefore, quality and treatment planning and delivery considerations for these techniques are paramount for patient safety. In 2021, ASTRO convened an interdisciplinary task force to assess the original IGRT white paper and update content where appropriate. Recommendations were created using a consensus-building methodology, and task force members indicated their level of agreement based on a 5-point Likert scale from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who selected "strongly agree" or "agree" indicated consensus. The IGRT white paper was published (Pract Radiat Oncol. 2022 Dec) and endorsed by the American Association of Physicists in Medicine (AAPM), American Association of Medical Dosimetrists, and American Society of Radiologic Technologists. Since the first IGRT paper was published by ASTRO in 2013, significant technological advancement has taken place. New and updated considerations in personnel requirements, staffing, education and training, equipment and technological requirements, quality management and assurance, IGRT program management, and safety considerations were reported. A 17-point consensus was reached and recommended in 5 areas surrounding program development, quality assurance, quality management, treatment delivery, and vendor engagement (Table 5, Summary of key recommendations). This IGRT white paper builds on the previous version and uses other guidance documents to primarily focus on processes related to quality and safety. IGRT requires an interdisciplinary team-based approach, staffed by appropriately trained specialists, as well as significant personnel resources, specialized technology, and implementation time. A thorough feasibility analysis of resources is required and should be discussed with all personnel before undertaking new imaging techniques. A comprehensive quality-assurance program must be developed to ensure IGRT is performed safely and effectively. As IGRT technologies continue to improve or emerge, existing practice guidelines should be updated regularly according to the latest AAPM Task Group reports. Patient safety in the application of IGRT is everyone's responsibility, and professional organizations, regulators, vendors, and end-users must demonstrate strong commitments to ensure that the highest levels of safety are achieved.