IROCA-TES: Improving Quality in Radiation Oncology through Clinical Audits -Training and Education for Standardization

Abstract

Background: Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to
detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consensus-
based quality indicators and then to compare the institutions in order to identify best practices.
Materials and methods: We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Poland,
Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation
Oncology through Clinical Audits — Training and Education for Standardization).
Results: Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural
differences. The institutions developed their own processes to suit their existing clinical practice.
Conclusions: We believe that this study will contribute to establishing the value of routinely performing multi-institutional
clinical audits and will lead to improvement of radiotherapy practice at the participating centres.

Full text

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REPORTS OF PRACTICAL
ONCOLOGY AND
RADIOTHERAPY
ISSN: 1507–1367
Address for correspondence: Julian Malicki, Greater Poland Cancer Centre, Poznan, Poland; e-mail: julian.malicki@wco.pl
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IROCA-TES: Improving Quality in Radiation Oncology
through Clinical Audits — Training and Education
forStandardization
Julian Malicki1, 2, Carla Lopes Castro3, Magdalena Fundowicz4, Marco Krengli5, 6,
Carmen Llacer-Moscardo7, Sebastian Curcean8, Carles Muñoz Montplet9, Luisa Carvalho3,
Ewelina Konstanty10, Tania Hernandez Barragan11, Carla Pisani5, Istvan Laszlo8, Miquel Macià Garau12,
Marta Kruszyna-Mochalska10, 1, Joana Lencart13, Dorota Zwierzchowska2, Alvar Rosello Serrano12,
Adelina Brezae7, Eva Loureiro Varela14, Piotr Milecki4, 1, Micol Zannetti5, Ovidiu Coza15, Eva Gonzalez16,
Debora Beldì5, Ferran Guedea12
1Electroradiology Department, University of Medical Sciences, Poznan, Poland
2Greater Poland Cancer Centre, Poznan, Poland
3Department of Radiotherapy, Instituto Português de Oncologia do Porto Francisco Gentil, Portugal
4Radiotherapy Ward I, Greater Poland Cancer Centre, Poznan, Poland
5Department of Radiation Oncology, University Hospital “Maggiore della Carità”, Novara, Italy
6Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
7Montpellier Cancer Institute (ICM), Montpellier, France
8Department of Radiation Oncology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
9Department of Medical Physics and Radiation Protection, Catalan Institute of Oncology, Girona, Spain
10Medical Physics Department, e Greater Poland Cancer Centre, Poznan, Poland
11Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
12Department of Radiation Oncology, Catalan Institute of Oncology, Barcelona, Spain
13Medical Physics Service & Medical Physics, Radiobiology and Radiation Protection Group CI-IPOP,
Instituto Português de Oncologia do Porto
14Department of Information Systems, Catalan Institute of Oncology, (ICO) Barcelona, Spain
15Department of Radiotherapy with High Energies and Brachytherapy, Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
16Department of Processes & Quality Management, Catalan Institute of Oncology, Barcelona, Spain
RESEARCH LETTER
Reports of Practical Oncology and Radiotherapy
2023, Volume 28, Number 3, pages: 429–432
DOI: 10.5603/RPOR.a2023.0035
Submitted: 03.03.2023
Accepted: 23.05.2023
© 2023 Greater Poland Cancer Centre.
Published by Via Medica.
All rights reserved.
e-ISSN 2083–4640
ISSN 1507–1367

Reports of Practical Oncology and Radiotherapy 2023, vol. 28, no. 3
https://journals.viamedica.pl/rpor
430
Introduction
Radiotherapy treatment planning and deliv-
ery has become increasingly complex in recent
years due to technological advances in radiothera-
py equipment. e introduction of advanced tech-
niques has improved clinical outcomes by allowing
for precise dose delivery to the target while reduc-
ing radiation doses to critical organs. However,
given the importance of ensuring the precision of
radiation delivery [1–3], it is essential to optimize
the radiotherapy process and to implement proce-
dures designed to detect and prevent errors [4]. In
this context, clinical audits are an important tool
to objectively assess clinical protocols, procedures,
and processes. Clinical audits are widely used
in medicine and oer numerous benets, includ-
ing the capacity to detect deviations from good
clinical practice.
e main aim of this project is to determine
adherence to a core set of consensus-based qual-
ity indicators—jointly established by the part-
ners in accordance with the best available evi-
dence—and then to compare the institutions in
order to identify best practices. A second aim
is to harmonise radiotherapy practice among
the participating centres and to promote the use of
advanced radiotherapy equipment (which is more
eective, accurate, and safer than older technol-
ogies), and to encourage the wider application of
clinical audits. e ultimate objective is to improve
treatment outcomes for patients.
Materials and methods
e clinical audits will evaluate clinical and treat-
ment-related data for 100 patients per tumour site
(rectal and prostate cancer) to verify adherence to
a set of quality indicators. e audit will be per-
formed by analysing the medical records of pa-
tients treated between January 1, 2018 through De-
cember 31, 2019.
Results
Despite the widespread availability of clinical
guidelines and protocols, radiotherapy practice
varies from country to country, in part due to his-
torical, economic, linguistic, and cultural dierenc-
es. In addition, new technologies tend to be incor-
porated only gradually, centre-by-centre, over time
[5]. As a result, institutions oen have to develop
their own processes to suit their existing clinical
practice. While some variation between countries
and centres is normal and expected, it is clear that
every eort must be made to adhere to established,
evidence-based protocols. is is especially im-
portant in radiation oncology, in which even small
deviations can have major negative eects.
To date, inter-institutional external clinical au-
dits have been used only sparingly in radiother-
apy [6–10]. However, there is a growing interest
in expanding the use of clinical audits and quality
indicators, including a directive from the Euro-
pean Union [11–14]. Given the proven benets of
ABSTRACT
Background: Clinical audits are an important tool to objectively assess clinical protocols, procedures, and processes and to
detect deviations from good clinical practice. The main aim of this project is to determine adherence to a core set of consen-
sus-based quality indicators and then to compare the institutions in order to identify best practices.
Materials and methods: We conduct a multicentre, international clinical audit of six comprehensive cancer centres in Po-
land, Spain, Italy, Portugal, France, and Romania as a part of the project, known as IROCATES (Improving Quality in Radiation
Oncology through Clinical Audits — Training and Education for Standardization).
Results: Radiotherapy practice varies from country to country, in part due to historical, economic, linguistic, and cultural
dierences. The institutions developed their own processes to suit their existing clinical practice.
Conclusions: We believe that this study will contribute to establishing the value of routinely performing multi-institutional
clinical audits and will lead to improvement of radiotherapy practice at the participating centres.
Key words: radiotherapy; clinical audit; quality indicators
Rep Pract Oncol Radiother 2023;28(3):430–432

Julian Malicki et al. IROCA-TES
431
https://journals.viamedica.pl/rpor
external audits, together with the need to harmo-
nise clinical practice in Europe, our group previ-
ously carried out a multicentre clinical audit in
four dierent European countries (Spain, Poland,
Portugal, and Italy). e results of that study,
known as IROCA (Improving Quality in Radia-
tion Oncology through Clinical Audits) [15, 16],
revealed important dierences in clinical practice
in radiotherapy planning and delivery for rectal
and prostate cancer.
Currently, our group is conducting a multicentre,
international clinical audit of six comprehensive
cancer centres in Poland, Spain, Italy, Portugal,
France, and Romania. is project, known as IRO-
CA-TES (Improving Quality in Radiation Oncology
through Clinical Audits–Training and Education for
Standardization), involves the following centres:
1) Catalan Institute of Oncology (ICO, Barcelona,
Spain), 2) Greater Poland Cancer Centre (GPCC;
Poznan, Poland), 3) Instituto Português de Onco-
logia do Porto Francisco Gentil (IPO, Porto, Portu-
gal), 4) University Hospital Maggiore della Carita
(UPO, Novara, Italy), 5) Cancer Institute of Mont-
pellier (ICM, Montpellier, France), and 6) e On-
cology Institute Prof. Dr. Ion Chiricuta (IOCN,
Cluj Napoca, Romania).
e IROCA-TES project can be considered,
at least partly, a follow-up to the original IROCA
study. However, the new study has been expand-
ed to include more centres and more patients. In
addition, the study design has been improved
and streamlined based on our previous experience.
e focus will be on evaluating medical, do-
simetric, and technical data related to diagnosis
and treatment. A questionnaire will be used to
guide collection of the study data, which will then
be entered into a purpose-built online database.
Aer all data have been collected and entered into
the database, the auditing team will prepare a re-
port and meet with the audited institution to dis-
cuss the results. A series of meetings will be held
to discuss the ndings and to reach a consensus
on harmonising the radiotherapy procedures
and processes.
Conclusion
e primary objectives of this study are to im-
prove clinical practice at the participating centres
and to identify “best practices”, which can then be
implemented at all participating centres to improve
treatment outcomes for the benet of our patients.
Finally, we believe that this study will contribute
to establishing the value of routinely perform-
ing multi-institutional clinical audits.
Conict of interest
None declared.
Financial disclosure
None declared.
Acknowledgements
We thank Bradley Londres for professional lan-
guage editing.
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