E-poster Presentation 2014 World Cancer Congress

Quality indicators for radiation treatment: A global perspective (#549)

Jeff Cao 1 2 , Michael Brundage 2 3 , Holly Donaldson 4 , Peter Dunscombe 4 5 , Crystal Angers 5 6 , Louise Bird 7 , Jean-Pierre Bissonnette 5 8 , Suzanne Drodge 2 9 , John French 10 11 , Caitlin Gillan 8 11 , Eshwar Kumar 12 13 , Gunita Mitera 13 , Matthew Parliament 2 9 , Lianne Wilson 7 , Erika Brown 7 , Michael Milosevic 2 8
  1. London Regional Cancer Centre, London, Ontario, Canada
  2. Canadian Association of Radiation Oncology, Canada
  3. Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada
  4. Tom Baker Cancer Centre, Calgary, Alberta, Canada
  5. Canadian Organization of Medical Physicists, Canada
  6. The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
  7. Canadian Partnership for Quality Radiotherapy, Canada
  8. Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  9. Cross Cancer Centre, Edmonton, Alberta, Canada
  10. British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  11. Canadian Association of Medical Radiation Technologists, Canada
  12. Saint John Regional Hospital, Saint John, New Brunswick, Canada
  13. Canadian Partnership Against Cancer, Canada

Background and Context:

Radiotherapy (RT) is an important treatment for cancer but is unavailable in many low and middle-income countries (LMICs). There is a UICC initiative to quantify the global investment necessary to make RT universally accessible. An important consideration is assuring quality and safety. Many existing RT quality and safety guidelines were developed in a top-down manner from experience in developed nations, are not readily adapted to LMICs and are not well suited to measuring programmatic or systems-level performance as drivers of quality improvement.


Develop and validate RT key quality indicators (KQIs) to motivate practice improvement and harmonization of care


The Canadian Partnership for Quality Radiotherapy (CPQR) used a Delphi process with engagement of front-line providers to develop KQIs that are adaptable to different environments and changing practice patterns over time.

Programme/Policy Process:

A literature review identified an initial set of KQIs. The first Delphi round involved oncologists, physicists, therapists and administrators from across Canada who were asked to rate each KQI for importance, clarity and feasibility. This was followed by a second in-person Delphi round, during which the KQIs were revised to build consensus. Participants reviewed and endorsed the final set of KQIs prior to dissemination.

Outcomes/What was learned:

The literature review identified 454 RT quality guidelines that were consolidated to form 51 KQIs in four categories: programmatic organization, personnel, equipment and policies/procedures. From the initial Delphi round, there was high agreement about importance in 63% of the KQIs, clarity in 49% and feasibility in 45%. The KQIs were revised during the in-person meeting, resulting in a final set of 45 KQIs (available at www.cpqr.ca). There was >90% agreement for >90% of these KQIs, which are now used extensively in Canada. They are easily adapted to LMICs using a similar methodology with engagement of local practitioners.