Since 1969, the International Atomic Energy Agency (IAEA) has been internationally and actively involved in the development and the installation of dosimetric audits in radiotherapy. In order to meet the needs of various countries, the IAEA decided to develop more clinically focused audits. As a result, an advisory group composed of radiation oncologists (RO), medical physicists (MP) and Radiation Therapists (RTT) also known as QUATRO (Quality Assurance Team for Radiation Oncology) was created in 2005 (1).

In 2007, the group published “Comprehensive Audits of Radiotherapy Practices: a tool for quality improvement” (2). This document describes, in a complete way, the guidelines necessary for the conduct of comprehensive audits which address equipment, infrastructure and clinical practices of the radiotherapy department, the whole approach being patient-focussed. The interpretation of the results of the audit is in function of the criteria of “good practices” appropriate to radiotherapy quality standards. In Belgium, action 16 of the cancer plan (2009) allowed the employment of persons in charge of quality in all Belgian radiotherapy departments in order to establish quality management systems in each one of these departments (3). In the same way, the College of Radiotherapy initiated the training of QUATRO auditors and since 2010, 5 radiotherapy departments a year are audited based on the QUATRO methodology. As of 2015, all radiotherapy departments have been audited.

The comprehensive, clinical and “patient-oriented” character of the QUATRO audits confers undeniable advantages to these types of audits. Nevertheless, an internal initiative of highlighted the need for developing certain parts of the QUATRO audits in order to optimize the evaluation of quality management systems (QMS). This document, also known the QMRT tool, aims at describing guidelines for the implementation and the evaluation of a quality and risk management systems in radiotherapy departments. It is partly based on the ISO 9001 standard while adapting it to the Belgian radiotherapy departments and this in a comparable manner as the ASN n°5 guide (4).

Download the QMRT tool here.


1. Izewska, J., et al., et al. IAEA quality audits in radiotherapy. European Journal of Medical Physics. 2014, Vol. 30, Suppl 1.
2. International Atomic Energy Agency. Comprehensive audits of Radiotherapy practices: a tool for quality improvement – Quality Assurance Team for Radiation Oncology (QUATRO). Vienna : s.n., 2007.
3. SPF. Plan Cancer – Action 16. [Online] 2009.
4. ASN. ASN Guide n°5: Management Guidelines for Safety and Quality in radiotherapy. ASN. [Online] 04 10, 2009.