On request, the IAEA performs comprehensive audits of radiotherapy programmes to assess the whole process, including aspects such as organization, infrastructure and clinical and medical physics components. The objective of a comprehensive clinical audit is to review and evaluate the quality of all components of the practice of radiotherapy at the institution, including its professional competence, with a view to quality improvement. A multidisciplinary team, known as Quality Assurance Team in Radiation Oncology (QUATRO), comprising a radiation oncologist. a medical physicist and a radiation therapist, are required to carry out the audit. The present publication provides revisions of the QUATRO guidelines published in 2007, by incorporating new procedures relevant to newer technologies and modalities that have become routinely used in radiotherapy centres in the interim period.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
  • 1.5. IAEA activities in dosimetry auditing
  • 1.6. Purpose of a quality audit
• 2. AUDIT STRUCTURE FOR QUATRO MISSIONS
  • 2.1. Request for a QUATRO audit
  • 2.2. Composition of the on-site audit team
  • 2.3. Preparation for the audit
    • 2.3.1. Role of the institution
    • 2.3.2. Role of the auditors
    • 2.3.3. Role of the IAEA
  • 2.4. Guiding principles and procedures of the audit
    • 2.4.1. Entrance briefing
    • 2.4.2. Assessment
    • 2.4.3. Exit briefing
  • 2.5. Conclusions of the audit team
  • 2.6. The audit report
  • 2.7. Dissemination of the report
• 3. INFRASTRUCTURE
  • 3.1. Context of the radiotherapy department
    • 3.1.1. Objectives of a radiotherapy department
    • 3.1.2. Patient demographics
  • 3.2. Structure of the radiotherapy department
    • 3.2.1. Personnel
    • 3.2.2. Departmental operation
    • 3.2.3. Premises
    • 3.2.4. Radiotherapy equipment
  • 3.3. Communications
  • 3.4. Workload
    • 3.4.1. Patient throughput on radiotherapy equipment
    • 3.4.2. Statistics
  • 3.5. Considerations for the introduction of new technology in the radiotherapy department
  • 3.6. Overall assessment of audit findings
• 4. PATIENT RELATED PROCEDURES
  • 4.1. Identification of patients
  • 4.2. Diagnosis and staging
  • 4.3. Indications and decision to treat
  • 4.4. Treatment preparation: instructions for planning
  • 4.5. Prescription and planning
  • 4.6. From planning to delivery
  • 4.7. Treatment delivery: teletherapy
  • 4.8. Deviations in radiotherapy administration
  • 4.9. Brachytherapy
  • 4.10. Documentation of treatment
  • 4.11. Follow-up
  • 4.12. Review of typical treatments
• 5. EQUIPMENT RELATED PROCEDURES
  • 5.1. Equipment quality assurance: aspects related to medical physics
    • 5.1.1. Introduction
    • 5.1.2. Quality assurance checklists for medical physicists
    • 5.1.3. Verification of consistency of dosimetry data and procedures
    • 5.1.4. Exit interview and the end-of-mission report
  • 5.2. Equipment quality assurance: aspects related to radiation therapists
    • 5.2.1. Introduction
    • 5.2.2. Quality assurance checklists: aspects related to radiation therapists
• 6. QUALITY AND SAFETY MANAGEMENT
• 7. EDUCATION AND TRAINING PROGRAMMES
  • 7.1. Education programmes
  • 7.2. Training provided in the department
  • 7.3. Research
• Appendix I RADIATION ONCOLOGY IN LIMITED RESOURCE SETTINGS
• Appendix IIREMARKS ON THE CONSISTENCY OF THE TERMINOLOGY USED IN RADIOTHERAPY
• Appendix IIIREMARKS ON THE ENUMERATION OF PATIENTS AND CANCER CASES
• REFERENCES
• CONTRIBUTORS TO DRAFTING AND REVIEW