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      Proposición de un programa de garantía de calidad de la radioterapia en los niños: aspectos médicos Translated title: PROPOSITION OF A QUALITY ASSURANCE PROGRAM OF RADIOTHERAPY IN CHILDREN: MEDICAL ASPECTS

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          Abstract

          La radioterapia constituye una de las armas terapéuticas básicas en la atención de los tumores malignos de los niños. Para poder garantizar los objetivos del tratamiento radiante es preciso aplicar un Programa de Garantía de Calidad, que comprenda los aspectos médicos y físicos, estrechamente imbricados. En este trabajo nos referiremos a una proposición de Programa de Garantía de Calidad de la Radioterapia en los niños en sus aspectos médicos. El programa de sería aplicado a todo niño sometido a tratamiento radiante, y constituiría un sub-programa dentro del Programa de Garantía de Calidad Nacional. Entre los aspectos médicos incluye: a) los programas o políticas de tratamiento; b) los elementos técnicos y físicos, como controles en equipos de simulación, irradiación, etc., y la correcta aplicación diaria del tratamiento indicado y planificado y c) revisiones periódicas de los programas de tratamiento, seguimiento de los casos y resultados obtenidos. Cada acápite comprende: 1) aspectos a auditar, y 2) cómo auditar. De todo lo anterior se infiere la necesidad de tener y aplicar un Programa de Garantía de Calidad del tratamiento radiante, que garantiza un tratamiento de calidad óptima.

          Translated abstract

          Radiotherapy is one of the basic therapeutic tools in the attention of malignant tumors in children. To guarantee the objectives of the radiant treatment it is necessary to apply a Quality Assurance Program comprising the medical and physical aspects closely related. In this paper, we refer to a proposition of the Quality Assurance Program of Radiotherapy in children in its medical aspects. The program will be applied to every child undergoing radiant treatment and it will be a subprogram within the National Quality Assurance Program. Among the medical aspects, we find: a) the treatment programs or policies; b) the technical and physical elements, such as controls in simulation equipment, irradiation, etc., and the correct daily application of the indicated and planned treatment; and c) periodical reviews of the treatment programs, follow-up of cases and obtained results. Each separate paragraph includes: 1) aspects to be audited, and 2) how to audit. From the above, it is inferred the need to have and apply a Quality Assurance Program of the radiant treatment guaranteeing a treatment with optimum quality.

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          Multinational assessment of some operational costs of teletherapy.

          Decisions in planning radiotherapy facilities in countries with limited financial resources require information on economic factors to make provision for sustainability. This study aims at acquiring data on some of these factors involved in delivery of teletherapy in 11 countries of different economic status. Representatives of three European, one African, three Latin American and four Asian countries, were identified from radiation oncology institutions that operated both cobalt and linac teletherapy machines. Productivity data were prospectively collected for the year 2002. A detailed log was recorded for each machine over an arbitrary two-week period. Data on quality assurance (QA), maintenance, the capital costs of each machine, and the source replacement costs for the cobalt units were also recorded. Both linear accelerators and cobalt machines treat more than 10,000 fractions per year per machine with 2.5 and 2.3 fields per fraction, respectively. The capital costs of the machines vary considerably, with a factor of more than 10 for linear accelerators. Cobalt sources show a huge variation in price. The median costs of QA and maintenance of a linac was US$ 41,000 compared to US$ 6000 for cobalt machines. This results for the economic factors considered in median costs per fraction of US$ 11.02 for linear accelerators and US$ 4.87 for cobalt machines. These figures do not include the costs for physicians. The variation of the costs per fraction is more due to the result of differences in machine usage and costs of equipment than of national economic status. A treatment fraction on a linac with functionality comparable to cobalt, costs 50% more than cobalt therapy. This project shows that it is possible to collect data on economic factors prospectively as well as retrospectively.
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            Staged informed consent for a randomized clinical trial in childhood leukemia: impact on the consent process.

            Children Cancer Group (CCG) 1991 is the first childhood acute lymphoblastic leukemia trial within CCG that allowed the utilization of a staged approach to the consent process. One hundred and forty subjects participated in the Project on Informed Consent which compared the primary outcome measures in the consent process of patients enrolled in CCG-1991 with those enrolled in other CCG leukemia studies. The parents' trust scores were higher for the CCG-1991 compared with other protocols. Eighty percent of parents enrolled in CCG-1991 understood the distinction between the randomized clinical trial and the standard treatment arm, compared with 62.5% in the other studies, P = 0.05. Multiple other outcome measures suggested a positive impact from staged informed consent. Our results suggest that a consent process with a staged approach can help investigators obtain a more truly informed consent. Future research is needed to confirm the benefits of the staged approach to the informed consent process. Copyright 2004 Wiley-Liss, Inc.
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              Principles and practice of radiation oncology

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                Author and article information

                Journal
                ped
                Revista Cubana de Pediatría
                Rev Cubana Pediatr
                Centro Nacional de Información de Ciencias Médicas; Editorial Ciencias Médicas (La Habana, , Cuba )
                0034-7531
                1561-3119
                March 2005
                : 77
                : 1
                Affiliations
                [01] Ciudad de La Habana orgnameInstituto Nacional de Oncología y Radiobiología. Departamento de Radioterapia. jalert@ 123456infomed.sld.cu
                Article
                S0034-75312005000100008 S0034-7531(05)07700108
                a1a4ee09-17f2-4318-93c8-2d31b2283bbd

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 01 October 2004
                : 15 December 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS DE REVISIÓN

                Radioterapia en niños,Programa de Garantía de Calidad,auditoría de tratamientos radiantes,Radiotherapy in children,auditing of radiant treatments,Quality Assurance Program

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