In 2000, the Norwegian Radiation and Nuclear Safety Authority (DSA) initiated work to develop a national quality assurance programme in radiotherapy. The program was named KVIST: i.e. Norwegian abbreviation of Quality Assurance in Radiotherapy.
The programme is performed by the multidisciplinary “KVIST Group” and aims to stimulate collaboration by focussing on clinical, technical and administrative problems that can be addressed and solved on a national level. An important objective is to establish a positive attitude towards quality assurance and better communication between centres and the various professions and professionals involved in radiotherapy, i.e. the oncologists, medical physicists and radiation therapy technologists. Information is also provided to other stakeholders such as health authorities and hospital administrators.
The KVIST group
The KVIST Group has, since 2005, comprised of 3 physicists, 2 oncologists and 1 radiation technologist, all professionals in shared positions between a radiation therapy department in a hospital and the DSA. The KVIST group coordinates a national reference group which again proposes working groups with a range of mandates, all with consideration to multicenter representation and in close collaboration with the medical societies.
KVIST ongoing work
The KVIST initiative has been a driving force in improving the quality of radiation treatment of cancer patients on a national basis, and has caused a range of harmonised national recommendations. This is achieved through a wide range of activities covering e.g.
- A system of annual reporting and documentation of radiotherapy activities in Norway provides useful statistics both for the hospitals in evolving their own quality systems, and for information to the health authorities
- An extranet solution serving the KVIST reference group, the working groups, the radiation therapy departments, the medical society and the health authorities, is under construction.
- A national system for reporting treatment errors is implemented as a part of the hospital quality systems, and condensed statistics sent annually to KVIST
- The dosimetric protocol TRS 398 from the International Atomic Energy Agency (IAEA) has been implemented in all Norwegian hospitals.
- KVIST provides two phantoms for quality control of the non-dosimetric information exchange between different data systems in the radiotherapy chain
- A post-qualifying educational system for medical physicists with calculus exercises is provided.
- A mutual understanding of the target volume definitions, implementing the reports from the International Commission on Radiation Units and Measurements (ICRU)
- A common radiotherapy prescription form is in course preparation with necessary parameters for radiotherapy, also to be used as a tool to register intended treatment.
- A system for clinical audits have been developed and tested on the treatment of bone metastases in 2002–2004. In 2008 we will further develop this method for treatment of breast cancer.
- As a national reference standard for clinical audits, radiotherapy guidelines are needed. Per 2008 a template is published, and draft guidelines are provided for gastro intestinal cancer and lung cancer, furthermore, work have been initiated to provide guidelines for prostate cancer and lymphomas.
- KVIST has established the Norwegian Radiotherapy Meeting, an annual meeting where oncologists, technologists and physicists meet to discuss radiotherapy related issues. Workshops dedicated specific cancer diagnoses are also arranged as part of these meetings.