Academic Journal
A centralized hybrid model for regulatory inspection readiness in a multi-site radiation oncology system.
| Title: | A centralized hybrid model for regulatory inspection readiness in a multi-site radiation oncology system. |
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| Authors: | Kalavagunta C; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA., Simonson D; Frederick Health Radiation Medicine, Frederick, Maryland, USA., Guerrero M; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA. |
| Source: | Journal of applied clinical medical physics [J Appl Clin Med Phys] 2026 Sep; Vol. 27 (9), pp. e70791. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley on behalf of American Association of Physicists in Medicine Country of Publication: United States NLM ID: 101089176 Publication Model: Print Cited Medium: Internet ISSN: 1526-9914 (Electronic) Linking ISSN: 15269914 NLM ISO Abbreviation: J Appl Clin Med Phys Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2017- : Malden, MA : Wiley on behalf of American Association of Physicists in Medicine Original Publication: Reston, VA : American College of Medical Physics, c2000- |
| MeSH Terms: | Radiation Oncology*/standards , Quality Assurance, Health Care*/standards , Particle Accelerators*/instrumentation , Particle Accelerators*/standards, Radiotherapy Planning, Computer-Assisted/methods ; Humans ; Quality Control ; Radiotherapy Dosage |
| Abstract: | Background: State regulatory inspections of radiation-producing treatment equipment combine a review of quality assurance and regulatory records with direct verification of facility and safety systems. When these activities are performed entirely on-site across multiple facilities, real-time document retrieval can prolong visits and divert clinical staff. Purpose: To develop and evaluate a centralized hybrid framework that separates advance document review from focused on-site verification during state-mandated annual inspections of photon linear accelerators. Methods: The framework was implemented across five photon treatment sites comprising 10 linear accelerators using an institutionally deployed cloud-based quality assurance platform (TotalQA, Image Owl Inc., Greenwich, NY). Site physicists uploaded machine- and site-specific records directly. A dedicated guest account allowed the inspector to review documents approximately 14 days before each visit. Document-verifiable items and photographs of required postings were reviewed remotely; audio/video monitoring systems, linac-on warning lights, staff access to applicable state regulatory requirements and personnel dosimetry records, written operating and emergency procedures, direct questions, and unresolved items remained on-site. A system-wide clinical deviation logbook containing protected health information was reviewed once in person at a central location. Operational outcomes included on-site duration, daily throughput, physicist support, schedule adherence, treatment impact, and inspection findings. Results: Historical inspections required approximately 120 min of on-site time per facility, based on calendar records, prior schedules, and staff recollection. During the hybrid implementation, on-site inspection time was approximately 30 minutes per facility based on records documented at the time of each inspection, representing an estimated 75% reduction. Daily throughput increased from approximately three sites per day to four sites per day. The inspector estimated that advance review required 1 to 2 h per site, generally closer to 2 h during the first cycle. All visits remained within scheduled blocks, no inspection-related treatment delays or interruptions occurred, and no documentation-related citations were identified. Conclusions: A centralized hybrid model was feasible for state-mandated annual inspections of linear accelerators in a multi-site radiation oncology system. Advance review reduced on-site document-navigation demands while preserving direct verification of physical and safety-related elements. Because remote-review time was estimated retrospectively, the findings support reduced on-site duration rather than reduced total inspector effort. (© 2026 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine.) |
| References: | J Appl Clin Med Phys. 2023 Nov;24(11):e14160. (PMID: 37793084) Med Phys. 2016 Jul;43(7):4209. (PMID: 27370140) Med Phys. 1999 Sep;26(9):1847-70. (PMID: 10505874) Pract Radiat Oncol. 2022 Sep-Oct;12(5):e434-e441. (PMID: 35431152) Clin Ther. 2021 Dec;43(12):2046-2063. (PMID: 34740466) Adv Radiat Oncol. 2024 Feb 09;9(5):101469. (PMID: 38550367) Med Phys. 2009 Sep;36(9):4197-212. (PMID: 19810494) J Radiol Prot. 2021 Nov 24;41(4):. (PMID: 34673558) |
| Contributed Indexing: | Keywords: Linac quality assurance; Multi‐site; Radiation oncology workflow; Regulatory inspection |
| Entry Date(s): | Date Created: 20260910 Date Completed: 20260910 Latest Revision: 20260914 |
| Update Code: | 20260914 |
| PubMed Central ID: | PMC13559466 |
| DOI: | 10.1002/acm2.70791 |
| PMID: | 42717726 |
| Database: | MEDLINE |
| ISSN: | 1526-9914 |
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| DOI: | 10.1002/acm2.70791 |