Critique of traditional quality assurance paradigm.

Radiotherapy was one of the first medical specialties to incorporate quality assurance (QA) into routine practices. Over the years, QA has become more comprehensive and time consuming. Following all the recommended QA procedures would burden the resources of most physics staffs. Much of the QA in recommendations serves no effective role. Performing all appropriate QA for the treatment units does not necessarily prevent events that result in patient injury. Equipment failures that have produced injury often occur with no warning. The human reactions to such failures will determine whether injury will follow. In addition, most events occur, not because of equipment failures, but because of human actions. Effective QA needs to consider procedures, rather than just equipment, and the human actions and interactions required for safe execution. New approaches address this problem.