Sharath Narayan

Medical Dosimetrist, Medical Dosimetry Certification Board

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Quality-can we define it, measure it and improve it in the context of treatment planning and contouring in radiation oncology?

The industry advertises "quality" with billboards containing claims of superior academic credentials or ownership of some piece of new technology. Despite these marketing claims, we all know that quality is not guaranteed simply by the credentials of providers or the presence of the latest piece of equipment.

Clinicians often point to different factors when thinking about what leads to quality treatment in radiation oncology. Understandably, we might consider the number of years of experience or credentialed status of the person preparing a treatment plan. Earning continuing education credits, working to enhance technological skill, or attending classes at professional meetings all represent the activities of a dedicated professional. However, these activities, by themselves, do not guarantee quality.

Recent articles in The New York Times highlighted to the public the risk of harm from variation in radiation treatment planning and delivery. Whether in the context of the Center for Medicare & Medicaid Services (CMS) value-based purchasing program or the need for evidence-based documentation to support credentialing initiatives, providers increasingly will focus resources on quality and patient safety. Successful strategies for developing a metric-based quality system will incorporate continual improvement philosophies such as those developed by W. Edwards Deming, a quality advocate who played an instrumental role in introducing the continual improvement culture into Japanese manufacturing. Deming's methods utilize data collection and statistical analysis to drive variability out of a process, thereby allowing modifications leading to quality improvement.

Properly executed continual improvement initiatives reduce variation and improve treatment performance. In the context of radiation therapy, a Deming system starts with an objective process allowing clinicians to benchmark themselves against their peers. Doing so eventually will result in improved quality.