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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?

Quality-can we define it, measure it and improve it in the context of treatment planning and contouring in radiation oncology? The first step in answering this question is to develop an objective, metric-based quality system allowing clinicians to benchmark their skills against their peers, measure the improvement of those skills and ultimately reduce planning and contouring variability. Such a system will lead to the sharing of best practices, continual improvement in the industry and, ultimately, improved outcomes for patients.

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. Properly executed continual improvement initiatives reduce variation.

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    Jun 24 2012: Of course we can define and measure quality. The question I have for you is what do mean by quality? There is a huge difference between what the patient views as quality and what clinicians view as quality. A true quality treatment plan incorporates both.

    Also, please link the NYT article. Of course there are variations in radiation treatment planning and delivery. There are different tumors. How many Greys of radiation are determined by the radiation oncologist along with the nuc. med. physicist and you can bet there is evidence-based practice parameters so I am not sure what quality you think we need.

    Please clarify.
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      Jun 28 2012: Thank you Linda,

      I will attach links to the NYT article and a couple of other ones. I will clarify as well. This initial textbox limited the amount I could post, so I basically just put up a conversation starter. Thanks for responding so thoughtfully. I will try to get a followup posted this evening.
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    Jun 23 2012: A bit confused with your question followed by your description........
    With question it seems you want an asnwer from audience......with your description followed, it seems you are answering yourself to conclude.....well that what I perceived by reading through others can have different feeling...

    My straight answer to your quest is
    YES then YES & again "YES & NO"

    In advertisement the word QUALITY is used so recklessly at times it sounds just like buzz word without giving any real clue what does it mean.