A fourth member with special competencies such as a radiation protection officer was engaged from the visited country. The composition of the on-site visit depends on the scope, level of development and expected content of the audit visit, but in all cases involved a radiation oncologist, a radiotherapy physicist and a radiation therapist (RTT). The publication contains checklists that auditors ought to complete, the analysis of which allows measurement of the degree of development of the audited institution. The Division of Human Health of the International Atomic Energy Agency (IAEA) published guidelines for audits of radiotherapy centres in 2007, known as QUATRO (“Quality Assurance Team in Radiation Oncology”) audits. Collected data and recommendations related to these aspects constitute the body of this publication.Īnalysis of indicators obtained through surveys and audits is a widely used methodology to measure performance of health services, including radiation oncology providers. The quality of oncology services also varies significantly between hospitals, and highly equipped academic centres coexist with facilities not meeting the minimal requirements of a basic clinic. The increasing migration of people from rural areas to cities has resulted in a predominance of urban health services deepening the inequity which affects the most vulnerable sectors. Most professionals specialized in cancer and its treatment are concentrated in the largest cities. The needs are covered in a 58─75 %, depending on the country. The availability of megavoltage therapy machines varies from less than 1 to more than 4 units per million people between the least and most equipped countries respectively. The cancer incidence in Central America is of 134 cases per 100,000 people per year, and 190 new cases is the number for South America. This is also the case for oncology in general and radiation oncology in particular. The scenario is characterized by significant heterogeneity in infrastructure and supply of services both within and between countries.
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There is notable inequity in access to health services within the region. Latin America includes countries in Central America, South America, the Caribbean and México, covering nineteen countries and about 600 million inhabitants. Scheduled follow-up visits were also stressed. Most recommendations pointed out different aspects related to strengthen human resources training and technological support to the audited centres. Many recommendations warned governments about the evident need for allocating more budgetary resources to radiotherapy. Recommendations to centres were classified as related to personnel, infrastructure, processes and institutional organizational aspects. Three institutions did not perform gynaecological brachytherapy, and one installation delivered around 900 teletherapy treatments annually without simulation, planning or dosimetry equipment for that purpose. Three centres lacking the minimum infrastructure were identified. Centres were provided with sufficient staff to meet the local demand, both in the case of radiation oncologists, physicists and radiation therapists. With few exceptions, local training programs for physicists and technologists were scarce and research was not an activity of interest among physicians. Forty percent of audited institutions were immersed in a health system that did not recognize cancer as a public health priority problem. IAEA provided a dosimetry kit for quality control.
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All 12 radiotherapy centres were successfully audited following the QUATRO method.