ACR Regulations for Treatment Planning

Accreditation offers both an educational opportunity and a workflow challenge to meet standards set by an accrediting institution. In Radiation Oncology, common accrediting bodies include the American College of Radiology (ACR), American College of Radiation Oncology (ACRO), and ASTRO Accreditation Program for Excellence (APEx). Through facility visits and program requirements, an in-depth analysis of the clinic is performed that seeks accreditation. Many clinics apply for accreditation due to the status of clinics. The goals of accreditation are to increase the quality of care for patients and educate clinics on how to improve their practice. For both patients and staff, accredited clinics show a level of safety and excellence.

There are many requirements for staff and procedures to receive or maintain the accreditation status. The program requirements outline what is necessary for treatment planning to be eligible for accreditation. While the standards provide guidelines for clinics, they can often increase in the workload for staff. One consistent requirement of ACR, ACRO, and APEx is to include the dose directives of the treatment plan. In addition to the DVH and isodose distribution on CT slices, accredited clinics need to document specific dose constraints of the targets and OARs. Manually documenting specific dose directives for each patient can be a time-consuming process.

Resources:

1. ACR: Summary of Radiation Oncology Practice Accreditation Program Requirements“

Treatment Planning:

1. Documentation of delivered doses to volumes of the target and non-target tissues, in the form of dose volume histograms and representative cross-sectional isodose treatment diagrams, should be maintained in the patient’s written or electronic record.

2. Treatment prescription and the isodose plan must be signed or electronically approved by the radiation oncologist and medical physicist prior to the initiation of radiation therapy.

3. The patient specific goals and requirements of the treatment plan, including the specific dose constraints for the target(s) and nearby critical structure(s), should be documented.”

2. ACRO: ACRO Accreditation: Medical Chart Upload Checklist“a written physician clinical treatment planning directive, signed and dated by the physician to include, but not limited to, the following criteria: Treatment Intent, Modality, Technique, Dose constraints for target volumes, Organs at risk, Time/dose considerations, Special tests, Ports and Devices.”

3. APEx: APEx Program Standards

“Treatment planning directive.2.2.1 A documented patient-specific planning directive guides treatment planning staff and defines target and normal tissue volume goals.”