Quality assurance in radiation therapy: European experience--present and future clinical efforts.
A high standard of radiotherapeutic practice must be sought in all phases of management of a patient with malignant disease. Radiation therapy must be appropriately chosen and integrated with surgery, cytotoxic chemotherapy and all other modes of treatment. The most suitable technique with a dose, fractionation and time regime must be devised and executed with technical and personal care. Follow-up to truly assess tumor control and morbidity is essential so as to guide the management of future patients. To achieve this in Europe great reliance is placed upon the training and qualification of the therapist and staff. In England a Fellowship of the Royal College of Radiologists in radiation therapy is regarded as essential for appointment as a permanent consultant within the Health Service. A high examination standard is set with pass rates ranging from 10 to 30%. High standards are applied to the professional qualifications for radiation physicists, nurses and technical staff. Most radiotherapy centers and departments have been visited by the Royal College in order to determine if the standard of staffing and equipment justifies inclusion in the list of training departments. There is, unfortunately, no control of continuing education of the consultant once appointed. In the countries belonging to the European economic union, a new Diploma in Radiation Therapy has been established to be a standard for consultant practice through all the countries included. In a few multi-center trials in the United Kingdom members of the central organization visit centers to look at the case notes and compare them with the material submitted from the trial center. This effort at monitoring clinical trials is only just beginning in the United Kingdom. The European Organization for Research and Treatment of Cancer has recently initiated a quality control study in some of the centers included in the Radiotherapy Group. A preliminary report has just appeared on the results of the clinical and dosimetric studies in 8 centers placed in 5 European countries. This first European effort appears to have been successful and further details will become available. These initiatives through research may well lead to wider studies of quality assurance in radiation therapy within Europe.