Radiation Oncology Services

Recommendation:

Radiation Oncology is one cancer treatment modality available onsite or by referral.

Overview

A radiation oncology program delivers safe and accurate treatment to curative and palliative patients.  A team composed of board-certified or board-eligible radiation oncologists, along with appropriately credentialed and certified physicists, dosimetrists, radiation therapists, and nursing support) is responsible for the simulation, planning, delivery of radiation therapy, and care of the patient receiving treatment. Also available to patients, either onsite or by referral, are multidisciplinary consultative services that include patient navigation, nutrition, social services, financial counseling, palliative care/pain management, genetic counseling, and research protocols.

Communication and coordination of care among specialists delivering care to care patients is key. Minutes from daily huddles can be used to keep providers updated. Download a template for morning huddle minutes here.

A radiation oncology program may include: Simulation (CT, conventional simulator), treatment planning, linear accelerator with conformal therapy and/or intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), stereotactic radiosurgery (SRS), stereotactic body radiation therapy (SBRT), brachytherapy, isotope, and ‘seed’ therapy availability, preferably onsite. Quality control mechanisms to reduce errors, patient-specific QA prior to treatment, independent verification of dose calculation for every new or changed isodose plan prior to delivery, machine-specific QA practices as defined by American Association of Physics in Medicine (AAPM), weekly chart rounds, physician peer review process, and a set of policies and procedures to guide the safe administration of treatment.

Certifications/Accreditations:

American College of Radiology (ACR), American College of Radiation Oncology (ACRO), or the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx) accreditation or program should adhere to standards of ACR, ACRO, or APEx. Accreditation by The Joint Commission, the American College of Surgeons Commission on Cancer, and the National Accreditation Program for Breast Centers, as appropriate, is also recommended.

Resources to Help:

Caseload Information: 

Several organizations offer caseload information for radiation oncology programs including ACRO, ACR, AAPM, and ASTRO’s “Safety is No Accident.”

Prior Authorization Tips:

At the time of a patient’s referral, begin to validate insurance coverage/participation. Refer patient to financial advocate/financial counselor to ensure best possible coverage. Physician should complete prescription and Physician’s Clinical Treatment Planning Note (PCTPN) as soon as possible (prior to simulation) and prior authorization should begin as soon as the prescription (type of treatment, number of treatments, CPT codes to be used, etc.) is known. Complete and accurate documentation is extremely important for insurance authorizations.

ACR's Imaging 3.0 helps map out the transition to value-based imaging care for radiologists.

 

ACCC Cancer Program Member: Bassett Healthcare– Radiation Oncology

Bassett Radiation Oncology Program launched its daily morning Safety Huddle in October 2013.

“The overall goal of the daily safety huddle is to  ensure seamless and coordinated care among the physicians, nurses, therapists, dosimetry/physics, front office, care coordinators, dietitians, financial counselors,  social workers, and members from medical oncology from both of our treatment sites. The focus of the 15-minute huddle is to look at the current and next day to eliminate any avoidable bottlenecks regarding process, documentation, or patient needs.  Since implementation, the format has been revised as we learned how to best identify what should be discussed at the huddle, greatly reducing the number of delays and clinic interruptions while increasing communication between team members. Physician peer review (15 minutes) follows the huddle to allow the physicians time to review each others’ plan to ensure the best possible outcome for each patient.”

Safety Huddle Reporting:

  • Treating therapists report patient setup issues, guidance for patients on break, etc.
  • Simulation therapists discuss setups, treatment location, scheduling, etc.
  • Schedulers/nurses discuss clinic flow and referral timing for scheduling
  • Physics/dosimetry discuss upcoming boosts, give instruction for setups
  • Care coordinators report insurance verification issues/delays