Evidence-based design of a patient-specific quality assurance program through retrospective analysis of pretreatment and in vivo results
In brief
Combined radiotherapy quality checks detected nearly all high-priority treatment failures
In a five-year review of 18,558 pretreatment plans and 1,817 in vivo plans, a multi-method quality program detected nearly all high-priority failure modes, with machine output miscalibration the exception. Combining checks improved the accuracy of positive findings, and in vivo review flagged the most failures; how best to turn these results into safer treatment remains an open question.
- Journal
- Physics and imaging in radiation oncology (Q1)
- Published
- 9 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Esther Decabooter, Sebastiaan M J J G Nijsten
- PMID
- 42903664
- DOI
- 10.1016/j.phro.2026.101106
Why clinicians should know about it
- Picked for Medical Physics (paper of the day, 23 October 2026): Large-scale evaluation of multimodal pretreatment and in-vivo PSQA
Abstract
BACKGROUND AND PURPOSE: As radiotherapy techniques become increasingly complex, patient-specific quality assurance (PSQA) must evolve to detect a broad spectrum of potential failure modes across the treatment chain. This study presents a extensive evaluation of a multi-modal PSQA program by assessing its ability to detect clinically relevant failure modes and quantifying its efficacy. MATERIALS AND METHODS: A five-year retrospective analysis was conducted of an integrated PSQA program implemented at Maastro, combining secondary dose calculations, log-file based verification, and Electronic Portal Dosimetry (EPD) in both pretreatment and in vivo workflows. The efficacy of individual QA methods and the overall program was quantified using positive predictive values (PPVs). PSQA outcomes were linked to potential improvements in treatment planning strategies and delivery techniques. RESULTS: A total of 18,558 treatment plans were analyzed in the pretreatment workflow and 1817 treatment plans in the in vivo workflow. Nearly all high-priority failure modes could be detected except machine output miscalibration. Combining PSQA methods substantially improved PPVs across failure categories. The in vivo workflow flagged the most failure modes and additionally gives insight into possible improvements in planning strategies or treatment techniques. CONCLUSIONS: This retrospective analysis demonstrated that a comprehensive framework incorporating independent, purpose-specific PSQA methods is essential to detect a wide range of treatment deviations. Combining complementary methods improves the reliability and interpretability of results. The clinical impact of a PSQA program can be further enhanced by adopting more clinically meaningful evaluation metrics and using the results to guide the optimization of new treatment strategies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.