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Radiation Treatment Quality-Based Procedures


    Frequently Asked Questions about Radiation Treatment Quality-Based Procedures


    The Radiation Treatment Quality Based Procedure (RT-QBP) defines best practice radiation treatment protocols. The protocols and quality expectations reflect the best clinical evidence available in treatment for each type and sub-type of cancer. 

    We considered the following when developing the RT-QBP:

    • Jurisdictional scans
    • Evidence review of clinical guidelines and guidance documents
    • Clinical consensus from radiation treatment specialists across the province

    Protocol Development

    A radiation treatment protocol is a treatment plan that consists of a specific set of doses over a predetermined length of time using 1 or more treatment modalities. The radiation treatment protocols were developed and approved through a rigorous 4-step process.

    1. Research

    • Conduct a comprehensive jurisdictional scan of national and international literature
    • Gather supplementary patient volume information
    • Obtain clinical consensus and guidance from provincial radiation experts

    2. Development

    • Develop disease-specific radiation treatment protocols and quality expectations as per clinical best practices

    3. Approval

    • Use a clinical consensus process for approval by provincial radiation experts
    • Apply the nominal group technique to guide the approval process for treatment protocols and quality expectations

    4. Refinement

    • Refine protocols based on clinical feedback and additional evidence (if required)

    Clinical Trials

    Ongoing clinical trials evaluate radiation treatment protocols that may eventually become the standard of care. If a protocol becomes the standard of care, the cancer centre can then submit a request for a new radiation treatment protocol. 

    To learn more or to submit a request, see Clinical Trials - Radiation Treatment.

    Quality Expectations

    The quality expectations aim to ensure the highest quality of care as defined by the Radiation Treatment Program and regional cancer centres. Quality expectations are institutional requirements that must be in place for the delivery of high-quality and safe radiation treatment. The application of quality expectations to specific radiation protocols will promote standardization, safety and quality of care across Ontario cancer centres.  

    Overarching or disease-specific expectations

    Quality of care requirements may be disease-specific, or they may be overarching and apply across all disease sites. Quality expectations fall under 6 treatment phases:

    • infrastructure
    • pre-treatment
    • imaging and planning
    • quality assurance
    • treatment
    • post-treatment

    Twenty-two expert panels, 9 working groups and an advisory committee collaborated over 18 months to develop and approve the disease-specific and overarching quality expectations using the nominal group technique.

    Essential versus recommended expectations

    Some expectations are defined as essential for funding to be approved, while others are considered recommended approaches to optimize quality of care. For instance, in breast cancer, one essential quality expectation is that the heart should be contoured on the treatment planning computed tomography scan in accordance with Radiation Therapy Oncology Group guidelines. One recommended expectation is that at least 1 mammography should be performed within the first year after radiation therapy.

    The Radiation Treatment Program is developing a measurement strategy to prioritize reporting and analysis of key quality expectations.