Enhancing Compliance in Offline Procedural Image Review by Senior Radiation Therapists: A 2025 Quality Improvement Initiative at KFSH&RC

Introduction: Accurate image verification is essential for maintaining precision and patient safety in radiation therapy. At King Faisal Specialist Hospital & Research Centre (KFSH&RC), a gap was identified in the offline review of procedural images, with 57% of treatment images not being reviewed, posing a potential risk to treatment accuracy and quality assurance.

The aim of this study is to improve compliance in offline procedural image approval by senior radiation therapists from 57% to 30% by May 2025 and sustain ongoing improvement through standardized practice.

Methodology: Using the I.A.C.T. framework (Identify → Analyze → Change → Transform), the department introduced targeted interventions including workflow restructuring, staff education, and a KPI-based monitoring system. Weekly audits and Excel-based tracking ensured accurate data collection and accountability.

Results: Compliance improved to below 30% within six months, achieving the target despite an increased patient workload in 2025. Staff surveys revealed enhanced confidence, greater awareness of the importance of offline image review, and improved departmental communication.

Conclusion: Implementing a structured quality-improvement framework significantly increased compliance with offline image review and improved staff engagement. Continuous monitoring, feedback, and education have sustained performance gains and strengthened patient-safety culture. This initiative reinforces the critical role of senior radiation therapists in ensuring accurate, high-quality radiation therapy aligned with international standards.

Conflict of interests: The authors declare no conflict of interest.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

License: ©️ Author(s) 2026. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, and unrestricted adaptation and reuse, including for commercial purposes, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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