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Quality Assurance and Radiation Safety at UMHS

The New York Times has run a series of articles about treatment errors that have occurred in radiation therapy. We want to take this opportunity to provide you with more information about the quality of our program at the University of Michigan.

Training

With respect to your caregivers, our personnel are licensed and/or credentialed professionals in all areas of our program. Our training programs for residents, medical physics residents, and therapists are accredited. All members of your treatment team participate in continuing education within our department and nationally to ensure that we provide you with the best care. A number of our faculty members are national and international leaders in the delivery of quality care for radiation therapy.

Treatment Plan Verification

To ensure quality treatments, we follow processes that include multiple review steps prior to and during delivery of your course of treatment. You are cared for by a team of physicians, physician assistants, nurse practitioners, dosimetrists, therapists, and physicists. After your CT simulation, a treatment plan is created following your physician’s requirements to provide you with the best care. After your physician has approved your treatment plan, a physicist reviews the plan prior to your first treatment. The review is performed to assess the quality of the plan and the integrity of the data transfer of the plan information to the software used for delivery of your plan at the treatment unit (linear accelerator).

For patients who receive intensity modulated radiation therapy, an additional step is required to verify the integrity of the treatment plan at the treatment unit prior to the first day of treatment. This verification is done at our institution by measurement of your full treatment plan. The results must be reviewed and approved by a physicist before treatment can begin.  Prior to the delivery of each fraction, the therapists who care for you at the treatment unit verify your physician’s prescription, the plan information, and then the delivery of that plan. The therapists also use the cameras and intercoms to monitor you during treatment. During the course of your treatment, your progress through treatment is reviewed by your caregivers. This review includes weekly review of the treatment delivery and parameters related to your care.

A number of additional quality assurance steps are performed for patients receiving specialty procedures which include stereotactic radiosurgery and stereotactic body radiation therapy programs performed on a linear accelerator. All treatment plans are developed by a team of physicians, dosimetrists, and physicists.

For stereotactic radiosurgery that involves the use of a head frame for precise positioning, the alignment of your treatment target is verified on the linear accelerator before your radiation treatment utilizing a complementary specialized frame that is positioned precisely for your treatment plan. A series of redundant checks is performed to ensure the accuracy of the treatment parameters, and the radiation dose to be delivered from each beam. The field shaping for each beam is also verified. The accuracy of the treatment setup is confirmed by the physics team and separately by the physician with x-ray imaging immediately prior to your treatment. During treatment, the physicist is present with the therapist. The physicist and the therapist compare all beam parameters with the treatment plan prior to the delivery of each beam.

For patients receiving stereotactic body radiation therapy, your treatment planning CT scan obtained earlier is transferred to the computers at the treatment unit, and used to help position you accurately for each treatment. In addition to the standard quality assurance steps performed for all treatments, the jaw positions and field shapes on the treatment machine are reviewed by a physicist in the treatment room prior to the start of your treatment course.

At the University of Michigan, our entire clinic is committed to constant vigilance regarding safe delivery of patient care.