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What kind of QA documentation is expected in the ACR Radiation Oncology Practice Accreditation (ROPA)?
The following QA documentation is required:
- Commissioning: Treatment unit, treatment planning and new treatment techniques such as IMRT, SRS/SBR
- ADCL records
- IROC output independent check
- Treatment machines: Daily, monthly and annual QA
What is a physics QA manual?
A physics QA manual is a set of policies and procedures describing all aspects of the radiation oncology physics program.
What is required for treatment planning system QA?
Please refer to the report of the AAPM Radiation Therapy Committee Task Group 53 or AAPM Medical Physics Practice Guideline 5a for treatment planning system QA information.
Do I need a second (backup) dosimetry system?
Yes, you will need at least one backup dosimetry system. You should have documentation that it has been intercompared periodically to the calibrated system.
What type of documentation do I need for treatment machine imaging QA (e.g., CT, EPID, kV imagers)?
Your documentation should show evidence of daily, monthly and annual QA following the report of the AAPM Quality Assurance and Outcome Improvement Subcommittee Task Group 142 and other pertinent AAPM guidelines.
What is required for periodic imaging QA (e.g., CT simulator, simulator, PET/CT)?
For periodic imaging QA, please refer to the report of the AAPM Radiation Therapy Committee Task Group 66. A qualified medical physicist should perform an annual system dose check.
What is an independent verification of output of each treatment unit beam?
Independent verification of output can be measured by TLD/OSL or by a separate independent medical physicist using their equipment.
What QA is required for my barometer and thermometer?
You should perform an annual comparison of these field instruments to a standard system.
What type of peer review documentation is required for a medical physicist (solo vs. multi practice)?
Solo physicist sites should refer to and follow AAPM TG 103. Multi-physicist sites should construct a policy to address the performance of annual and on-going peer review. This policy should include documentation of an annual performance evaluation and proof that QA processes are reviewed by another medical physicist who did not perform the original work. It is also recommended that the on treatment chart check process be rotated amongst the group physicists..
Do I need a policy and procedure for high dose (> 300cGy/fraction) treatments?
Yes. The physics manual should have a policy that specifically states that the plan/calculation will be checked prior to treatment. However, if your policy states that all plans and calculations have to be reviewed prior to treatment, no additional policy is needed.
Are weekly chart checks by a medical dosimetrist acceptable?
No. A qualified medical physicist (QMP) must review each patient’s chart on a weekly basis. Please reference ACR/AAPM Technical Standard for the Performance of Radiation Oncology Physics for External Beam Therapy (Section VI.C.3a).
What is considered an end of treatment (EOT) chart check?
An EOT chart check is a final review of all plans, calculations and patient dosimetry readings, weekly chart checks, etc. An EOT chart check must be performed within one week of the patient’s treatment completion.
What is required for brachytherapy radiation safety documentation?
Brachytherapy radiation safety documentation must include at a minimum evidence of a post-procedure survey. Please refer to NRC regulations.
What is required for brachytherapy source calibration?
Brachytherapy source calibration documentation must show that it was performed using an ADCL Well Chamber and the calibration check was done prior to source usage.
What are the responsibilities of the Quality Assurance Committee?
The Quality Assurance Committee is responsible for the following:
Reviewing/following up on
- medical events
- machine down time
- percentage of weekly chart checks and EOT checks
- any treatment complications
- department clinical statistics (e.g., morbidity and mortality, outcome and focus studies, etc.)
- patient satisfaction surveys
- MD and Physicist peer review
- medical physicist QA reports
Establishing and reviewing clinical processes
Discussing process and clinical errors, establishing cause, effect and solutions
What published material should I reference for the ROPA program?
Please refer to the following materials for ROPA:
- ACR/ASTRO Practice Parameters and ACR/AAPM Technical Standards
- AAPM task group reports
- AAPM medical physics practice guidelines
- ASTRO white papers
- NRC regulations