ANALYSIS OF QA/QC (QUALITY ASSURANCE/QUALITY CONTROL) IMPLEMENTATION IN RADIOTHERAPY AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

Abstract

The efficacy and safety of radiotherapy, a cornerstone in modern cancer treatment, are profoundly dependent on stringent Quality Assurance (QA) and Quality Control (QC) protocols. Despite advancements in technology, deviations in treatment delivery can lead to suboptimal clinical outcomes and increased risks to patients. Recent reports indicate a persistent global challenge in maintaining consistent QA/QC implementation across diverse healthcare settings, with particular concerns arising in resource-limited environments. While theoretical frameworks for QA/QC in radiotherapy are well-established, empirical evidence detailing the practical challenges and successes of their implementation, especially within large public hospitals in developing nations, remains scarce. This study addresses this critical gap by investigating the current state of QA/QC implementation in radiotherapy at RSUP H. Adam Malik Medan, a prominent referral center, aiming to provide a nuanced understanding of its operational realities. This research comprehensively analyzes the implementation status of QA/QC procedures within the radiotherapy department at RSUP H. Adam Malik Medan, specifically seeking to identify the extent of adherence to established QA/QC guidelines, pinpoint existing barriers to effective implementation, and evaluate the perceived impact of these practices on treatment accuracy and patient safety, guided by the principles of the International Atomic Energy Agency (IAEA) recommendations and relevant national regulations. A mixed-methods research design was employed, integrating quantitative data collection with qualitative insights to provide a robust analysis. A cross-sectional survey was administered to a sample of 45 healthcare professionals (radiation oncologists, medical physicists, radiotherapists, and nurses) directly involved in radiotherapy services, selected through a stratified random sampling technique to ensure representation across different roles. The survey instrument, developed based on validated QA/QC checklists and adapted from existing literature, demonstrated high internal consistency (Cronbach's Alpha = 0.89). In-depth semi-structured interviews were conducted with 15 key personnel to explore their experiences, challenges, and suggestions regarding QA/QC implementation. Quantitative data were analyzed using descriptive statistics and inferential tests (e.g., chi-square), while qualitative data underwent thematic analysis to identify recurring patterns and themes. The findings reveal a moderate level of QA/QC implementation, with significant variations across different procedural categories. For instance, daily machine checks and patient chart reviews exhibited high compliance rates (85% and 78%, respectively), whereas comprehensive dose verification and image-guided radiotherapy (IGRT) quality checks showed lower adherence (55% and 60%, respectively). Statistical analysis indicated a significant correlation between the availability of dedicated QA/QC personnel and higher implementation scores (${\chi}^2$(1, N=45) = 12.56, p < 0.01, Cramer's V = 0.53). Qualitative data highlighted key barriers, including insufficient budgetary allocation for advanced QA equipment, limited training opportunities for staff on emerging QA protocols, and workload pressures impacting the time dedicated to meticulous QC procedures. Unexpectedly, a strong sense of shared responsibility for patient safety was consistently reported across all interviewed professionals, despite systemic challenges. This study concludes that while foundational QA/QC practices are in place at RSUP H. Adam Malik Medan, there is a clear need for enhanced systematic implementation, particularly for advanced verification techniques. The findings underscore the critical importance of adequate resource allocation and continuous professional development to bolster QA/QC effectiveness. Theoretically, this research contributes to the understanding of practical QA/QC challenges in large public hospitals in developing countries. Practically, it offers actionable insights for hospital administrators and policymakers to refine existing QA/QC frameworks, thereby improving radiotherapy treatment accuracy, minimizing errors, and ultimately enhancing patient outcomes. Future research should focus on longitudinal studies to assess the impact of targeted interventions aimed at improving QA/QC adherence.