Original Title: Control de calidad en radioterapia de intensidad modulada

Authors' objectives: 1. Perform an overview through a critical analysis of protocols, guidelines, recommendations, quality and safety standards and checks of Intensity modulated radiotherapy (IMRT) treatments. 2. Determine the extent to which different safety and quality protocols, recommendations and standards are implemented in the Spanish National Health Service. 3. Analyse the difficulties encountered in the dissemination of standards, process indicators and results in the services in which the IMRT technique is already implemented or is to be implemented in the near future. 4. Examine Spanish regulations relating to the IMRT technique (safety and quality checks); and compare these to the legal codes of developed countries. 5. Draw up a checklist to include the different IMRT treatment processes, facilitate registration of activity and allow comparisons to be made.

Authors' results and conclusions: For objective 1: The extent to which IMRT protocols and guidelines are implemented at an international level varies greatly from centre to centre. Local protocols are applied in combination with or parallel to health care indicators of processes assignable to health service purchase contracts. Although the technique is well defined, this embraces a wide variety of different approaches and techniques. As a result of the difficulties that exist in making comparisons, establishing indicators is an extremely complex task, especially in view of the fact that the process is developing on a continuous basis. The widely varying approaches to IMRT make this process even more complex as IMRT involves a reduction in the number of patients who can be treated with the same piece of apparatus, as the level of demand on this service is already high. Therefore, the extent to which the technique can be implemented depends on this circumstance. For objectives 2 and 3: The degree to which the protocols and recommendations are implemented varies greatly. In a high proportion of cases, the IMRT process is currently being implemented or controlled and is not subject to standardisation at this time. For objectives 4 and 5: International and Spanish regulations represent a good reference framework for future developments although these are evidently insufficient to regulate actions that require more complex technologies such as the one examined in this document. The IMRT process requires a higher level of expertise than other conventional techniques, included within the national and international regulatory framework, and for this reason, the standard must be developed further.

Authors' recommendations: Recommendations 1: Clinical tests must be drawn up and fostered to provide sufficient evidence and corroborate the data of studies of prospective cases. Based on this, prepare clinical practice guidelines (CPG) that document the health care process, acceptable to the different agencies involved. Recommendation 2 and 3: these protocols and recommendations should be implemented in the quality clinical practice guidelines of the Spanish health care system, in order to document the IMRT process and allow process standards and results to be established on the basis of the indicators proposed in this document. Recommendations 4 and 5: regulatory frameworks should be modified to include the complex treatments required by new applied technologies both regarding the minimum technological requirements and the degree of competence of health professionals involved in the health care process. Likewise, it is advisable to use tools (such as the checklist developed in this study) that guarantee an adequate development of the process.

Authors' methods: 1. For objective 1: Perform an overview through a critical analysis of protocols, guidelines, recommendations, quality and safety standards and checks of IMRT treatments. 2. For objectives 2 and 3: Determine the extent to which different safety and quality protocols, recommendations and standards are implemented in the Spanish National Health Service through a survey carried out in the identified radiotherapic oncology centres and services that perform or expect to implement IMRT technique. 3. For objectives 4 and 5: Analysis of Spanish regulations relating to the IMRT technique. Preparation of a checklist of IMRT treatment processes.

Project Status: Completed

Year Published: 2008

URL for published report: https://www.euskadi.eus/contenidos/informacion/2008_osteba_publicacion/es_def/adjuntos/D_08_04%20radioterapia%20de%20intensidad%20modulada.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>