Radiotherapy Physics Quality Assurance and Management Practices in Less Resourced Facilities: An Initial Pilot Survey in Six Countries Followed by an Onsite Visit and Audit of Radiotherapy Centers in a Lower Middle-Income Country (LMIC)

Abstract

<h3>Purpose/Objective(s)</h3> To assess physics quality assurance (PQA) and practices in less resourced RT clinics to improve the quality of care. <h3>Materials/Methods</h3> An initial survey was conducted in 2020 to thirteen select RT centers in six countries. In 2021, from the survey outcome, our team conducted onsite visits to all the RT-centers in one of the countries: one private, and two public (Public-1- and –2). Public-1 in the capital and Public-2 in a regional capital. Follow-up surveys were sent to 17 medical physicists. Questions centered on the topic of equipment, institutional practice, physics quality assurance, management, and safety practices. Qualitative and descriptive methods were used for data analysis. We accessed operational challenges using a 5-point Likert system: machine downtime, patient related issues, power outage and staffing. <h3>Results</h3> We received a 100% response rate. Six (6/17) had 1-3 years of experience and two (2/17) have over 15 years of experience. Over 80% of respondents had experience with a treatment planning system. Private and public-1 have CT simulators located in RT clinic. Breast, genitourinary, Gynecologic, H&N were the most treated diseases in all three centers. All three (3) clinics have 3D conformal RT (3D-CRT), the private and public-2 have electron treatment modalities and only public-1 have IMRT treatment available. An audit during the visit showed that no single point diode patient specific QA is done for 3D-CRT patients and none of the institutions had a functioning diode to carry out this QA process. The average daily patient workload on external beam device for each clinic was LINAC: Private = 25, public-1 = 55, public-2 = 40; Co- 60: public-1 = 45, Public-2 = 25. Public-1 and-2 lacked the equipment necessary to conform to best practices in TG-142 and 198. Public-2 reported significant challenges in the operational challenges above with values of 4.5, 3 and 2.75 and 2.25. Notably Public-1 and-2 have peer review chart rounds which are attended by clinical oncologists, medical physicists, physicians, and physics trainees. All (17/17) responded to having a system of documenting, tracking, and trending patient related safety incidents but only one (1/17) physicist reported using a voluntary incident reporting system. Although not quantifiable audits during site visits show education and training remains the most important need in operating successful local PQA and management programs. In the initial survey RT centers in lower GNIpc country there was a direct correlation between QA needs and the country index. <h3>Conclusion</h3> The initial study showed a direct correlation between QA needs and the development index of a country which has led to the first of a continent-wide survey intended to spotlight PQA practices in LIMCs, the challenges faced, lessons learned, to help understand the gaps and needs to better support their local PQA and management programs.