Quality and Safety With Technological Advancements in Radiotherapy: An Overview and Journey Narrative From a Low- and Middle-Income Country Institution

Abstract

Purpose: To present an overview of quality and safety in radiotherapy from the context of low- and middle-income countries on the basis of a recently conducted annual meeting of our institution and our experience of implementing an error management system at our center.

Methods: The minutes of recently concluded annual Evidence-Based Medicine (EBM-2021) meeting on the basis of technology in radiation oncology were reviewed. The session on quality and safety, which had international experts as speakers, was reviewed. Along with this, we reviewed the literature for preventive and reactive measures proposed to manage errors including error reporting and learning systems (ILSs). Concise summary for the same was prepared for this article.

Results: We also reviewed the journey of development of our institutional ILS and present here a summary of achievements, challenges, and future vision.

Conclusion: Preventive and reactive measures must be followed to achieve high-quality and safe radiotherapy. Despite resource constraints, a successful ILS program can be developed in a low- and middle-income country center by first understanding the patterns of error and developing one that suits the working ecosystem.

FIG 1

Footprints of our error learning system and quality improvement program. The figure shows the main steps taken during the journey—cross-sectional audit (resulting in acceptance of errors and realization that an ILS is needed), development of TRIP, addressal of the errors, integration of TRIP into our indigenous oncology information system (ROIS), incorporation of QI programs (in collaboration with Stanford and Tata Trust), and dissemination of this system to other spokes of Tata Memorial Hospital. ILS, incident learning system; QI, Quality Improvement; TRIP, TMH Radiation Incident Program.