Novalis
Certified

The following program aspects must be clearly demonstrated by institutions providing SRS and/or SBRT services:

• Program goals should be documented for each specific disease site
• Processes for documentation, reporting, peer review, policies and procedures, clinical guidelines and continuous quality improvement must be defined
• Clear quality assurance processes that encompass all clinical and technical SBRT program aspects must be outlined
• Defined strategy for peer review, department and procedures, individual clinical care, physician and qualitative decisions must be transparent
• Personnel should demonstrate a thorough understanding of the SRS and/or SBRT literature within their particular specialty

Infrastructure:

• SRS and/or SBRT patient conferences for pre-treatment planning and post-treatment review and follow-up should be held on a regular basis
• Assessment of all clinical goals, identifying equipment and processes for simulation, immobilization, image guidance, management of organ motion and treatment delivery should be performed and documented
• External audits should be conducted prior to the initiation of clinical services
• Independent audits should be performed on a regular basis
• The institution must promote a culture and environment that fosters clear and open communication

Policies and structure:

• Guidelines should be developed for patient selection, treatment and follow-up based on nationally accepted protocols
• Tumor dose and OAR constraints should be determined by each disease site, incorporated into policies and procedures as well as clearly specified in each patient’s treatment record
• Checklists should be developed and utilized for all aspects of SRS and/or SBRT processes

Institutions providing SRS and SBRT services will be expected to demonstrate the employment of dedicated specialists including radiation oncologists, medical physicists and radiation therapists to support these programs. Personnel must have credentials and be properly trained within their respective field. They must also maintain their certification through formal maintenance programs offered by their respective boards.

Processes that often involve a number of diverse but interconnected elements such as selection, installation, integration, testing and clinical application of technology are critical to ensuring safe and effective SRS / SBRT delivery. SRS and SBRT have unique performance and quality assurance requirements and should be critically evaluated for each disease site and specific application.

• In addition to imaging and treatment devices, Novalis Certified centers should have:
  • Specialized dosimetry equipment
  • Immobilization devices
  • Technology for motion assessment management
  • Specialized phantoms and software

• Must incorporate SRS/SBRT-specific procedures for the equipment and processes
• Must require vendors to provide SRS/SBRT-specific acceptance testing procedures for their equipment and processes
• Must have documentation of the vendor’s acceptance testing

• Must follow national/international protocol
• Must have independent verification of calibration

• Must follow established standards and utilize the appropriate equipment for small field dosimetry
• Must incorporate end-to-end testing

• Must use appropriate dose for each disease site