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Figure 1. Comparison of T2
W
and T1
W
after Gd injection
MRI sequences in the case of standard PT (left) and in
pMBRT (right). The images were acquired 7 months after
irradiation. Important lesions (hematomas, edemas) are
observed in the T2
W
images, as well as an extensive BBB
breakdown in the standard PT case. The images
corresponding to the pMBRT irradiation showed no
significant damage.
Conclusion
Conclusion: pMBRT leads to an increase in normal tissue
resistance. This net gain in normal tissue sparing can
foster one of the main applications of proton therapy,
paediatric oncology, as well as open the door to an
efficient treatment of very radioresistant tumors, which
are currently mostly treated palliatively. The next step
will be to perform studies to unravel the biological
mechanisms involved in normal tissue sparing.
[1] Prezado et al. Med. Phys. 40, 031712, 1–8 (2013).
[2] Prezado et al., Rad. Research. 184, 314-21 (2015).
[3] Peucelle et al., Med. Phys. 42 7108-13 (2015).
Joint Symposium: ESTRO-CARO: Waiting times and QA
SP-0247 Driving Radiotherapy Quality Improvement:
The Canadian Experience
M. Milosevic
1,2
1
Princess Margaret Cancer Centre and University Health
Network, Radiation Medicine Program, Toronto, Canada
2
University of Toronto,
Department of Radiation Oncology, Toronto, Canada
The success of radiotherapy as an indispensible part of a
cancer control strategy depends on a wide range of
programmatic and system-level factors, including
effective quality management. Treatment delivered in a
suboptimal manner without appropriate oversight can lead
to poor clinical outcomes or, in extreme cases, severe
patient injury and death. In Canada, radiation treatment
quality and safety activities have largely evolved
independently in programs across the country with no
over-arching coordination. The Canadian Partnership for
Quality in Radiotherapy (CPQR) was formed in 2000 as a
catalyst to harmonize quality and safety on a national
scale.
CPQR utilized a bottom-up and top-down engagement
model to motivate pan-Canadian harmonization of
radiation treatment quality and safety. Guiding principles
included involvement of the three primary disciplines
involved in the delivery of radiation treatment, equal
representations from all regions of Canada, impactful
objectives aligned with the needs of the radiation
treatment community, broad engagement of front-line
practitioners and a person-centered focus with meaningful
patient involvement. As well, CPQR engaged key
stakeholder groups including Accreditation Canada, the
Canadian Institute for Health Information (CIHI) and the
provincial
cancer agencies.
CPQR developed and validated practice guidelines and
quality/safety indicators relating to program
performance, equipment performance and patients
engagement, as well as pan-Canadian radiation treatment
accreditation standards and a national system for
radiation treatment incident reporting. An independent
review found that CPQR initiatives produced substantial
and measurable improvements in the quality and safety
performance of Canadian radiation treatment programs,
largely attributable to the methods used to motivate
change and promote a culture of sharing and trust. CPQR
was described as: ‘… the first successful example in the
Canadian health care system where professionals from
different disciplines work together as a team to improve
the quality and safety of their practice’.
Looking forward, CPQR will capitalize on these successes
and the momentum within the Canadian radiation
treatment community to advance new quality and safety
initiatives, working with ESTRO and other international
partners. This will include a renewed focus on equitable
access to radiation treatment in Canada and the collection
and sharing of radiation treatment patient reported
outcomes, integrating improvements in the care of
individual patients with higher-level improvements in pan-
Canadian health system performance.
SP-0248 Radiotherapy Quality Management and
Improvement across Europe: variable approaches,
united view
N. Jornet
1
1
Hospital de la Santa Creu i Sant Pau, Medical Physics,
Barcelona, Spain
ESTRO vision states that “ Every cancer patient in Europe
will have access to State of Art Radiotherapy as part of a
multidisciplinary approach were treatment is
individualized for the specific patient’s cancer, taking into
account the particular patients’ circumstances”. Different
studies show that access to radiotherapy in European
Countries is far from being homogeneous and also the
quality management strategies and initiatives at national
level are not aligned. Quality and Safety are key elements
to demonstrate that Radiotherapy is a key player in cancer
cure. Therefore, to fulfill the vision, ESTRO, as an
overarching organization, has to find a way to align
European quality management strategies and quality
indicators and standards– guiding and supporting- without
overruling. This is challenging due to the diversity on
cultural and economic backgrounds of European
Countries. But this diversity is also an opportunity as we
can learn from different countries experiences. The
results of a survey on the actions being developed at a
national level in Quality Management and Patient Safety
show that the approaches differ. Some National Radiation
Oncology Societies are active in the definition of quality
indicators and standards while others focus on incident
and accident reporting and analysis or in the
implementation of clinical audits. On ESTRO side, ACROP
committee is publishing consensus guidelines which
together with ESTRO School are pillars to promote that
good practice in RT departments across Europe and
beyond. Furthermore, ESTRO is in a unique position to put
together existing initiatives and propose a set of quality
indicators and standards that could be used by the
different countries. In addition, whether ESTRO should
embark on accreditation of departments through Clinical
Audits has been discussed in the Physics Committee
strategy meeting in 2015, it is now under discussion at
ESTRO board.
Wrapping up, while the approaches differ, the vision is
unique “Equal access, high quality and safe radiation
therapy”. However, there is still a long way to harmonize
Quality Management practice through Europe and ESTRO
can play an important role to facilitate this
harmonization.
SP-0249 An Overview of Two Radiotherapy Quality
Initiatives in Canada
M.D. Brundage
1
1
Cancer Centre of Southeastern Ontario, Kingston,
Canada
This presentation will review two specific quality
improvement initiatives for the practice of radiation