• APEx Facility FAQs

  • Radiation Oncology Practices (ROPs) based in the United States may apply for ASTRO accreditation. ROPs may be either:

    1. Freestanding single facility
    2. Multi-site organizations
    3. Part of a hospital facility

    APEx defines a radiation oncology practice (ROP) as a medical practice offering radiation therapy services, utilizing the services of intra-disciplinary professionals under the direction of a board certified radiation oncologist. An ROP is a multi-site practice (e.g., a ‘main campus’ with satellite sites) with:

    1. All facilities located within a 50 mile radius;
    2. All of the facilities have common policies and procedures for key evidence indicators;
    3. All of the facilities have a medical director who is responsible for each facility and one individual from practice leadership who is responsible for the culture of safety standard operating procedure ; and
    4. All of the facilities have the same corporate ownership.

    Within the APEx Web portal, an ROP is referenced as a network.

    Applicants with a satellite located more than 50 miles from the main should contact APEx staff to discuss application options.

    Radiation Oncology Practices (ROPs) will submit an online facility application through the APEx Web portal supported by an external vendor. The application requires information on: 

    • Facility location and information 
    • Key contact personnel 
    • Number of patients treated annually and types of diseases 
    • Equipment (including simulation, treatment and brachytherapy machines) 
    • Medical record and planning systems 
    • List of physicians 
    • List of treatment modalities 
    When entering a multi-facility application, if the distance between facilities exceeds 50 miles the application the application is put on hold. Contact ASTRO staff at for instructions.

    Please check to ensure all information is completed.

    If applying as a multi-facility ROP you need to add a network for each satellite. The system will not let you continue until the satellite(s) are added.

    Once your application is complete and payment has been processed you will gain access to the self-assessment portion. The self-assessment is a preliminary process in which the main facility assesses their readiness for the facility visit and is an important aspect of APEx. This is a rigorous, yet beneficial, step of the accreditation program as it promotes the creation of and adherence to processes and policies that improve the quality of care and patient safety.  The self-assessment allows practices to examine and improve the practice’s processes as preparations are made for the facility visit.

    The self-assessment is a preliminary process in which the ROP assesses their readiness for the facility visit. The self-assessment is an important aspect of APEx. This is a beneficial and impactful step of the accreditation program as it promotes the creation of and adherence to processes and policies that improve the quality of care and patient safety. The Self-assessment allows practices to examine and improve the practice’s processes as preparations are made for the facility visit.

    The self-assessment includes a medical record review, upload of policies and procedures and other supportive materials. ASTRO staff and surveyors review the self-assessment and documentation.

    The ASTRO APEx Committee is charged with reviewing blinded facility reports based on the facility visit survey, and they issue accreditation determinations. The committee will make one of three determinations based on the final score and review of any additional information: accredit, provisionally accredit or denial.

    APEx accreditation lasts for a four year cycle.

    The full process is approximately 6 months. Note that time required for preparation may vary for different organizations based on their size, number of satellites and readiness for accreditation review.

    The base fee for practice accreditation is $14,000. An additional $5,000 is required for each additional facility (satellite) that meets the multi-facility criteria. 

    No, APEx was specifically designed by ASTRO.

    However, both COC and NAPBC accept APEx accreditation as fulfilling the radiation therapy component of their accreditation programs.

  • APEx Standards FAQs

  • APEx requires documentation in the medical record that each component of 1.1 is evaluated by the radiation oncologist prior to simulation or any pre-treatment preparation. Each indicator must be annotated unless there is an exclusion. Documentation must include one of the following for each component:

    • Positive finding (e.g. allergic to contrast, previous radiation treatment).
    • Pertinent negative (e.g. no known allergies, menopause 2002).
    • Non-applicable references (e.g. lab results N/A).
    • Confirmation of review (e.g. MRI Pelvis with contrast 3/27/15 reviewed).
    APEx assesses that a time out (a pause in proceedings) occurs to verify patient identification, correct treatment site, correct patient positioning and treatment plan parameters. For the APEx program, this is checked in the medical record review portion and therefore requires documentation or confirmation in the OIS that the elements are verified. There are many ways this documentation could be evidenced; e.g. checklist, sign-off, daily alert acknowledgement, etc. The check is not how you choose to record this verification, just to confirming it is documented prior to each treatment procedure.

    For evidence indicator 5.1.5, APEx is looking to see if the practice has a documented policy regarding the requirements for licensure, certificates, additional experience, and/or educational preparation in radiation oncology as defined by the practice. Though Safety is No Accident recommends the Oncology Certification from ONCC or the Radiation Oncology Nursing Certificate from OCN, they are just examples.

    APEx does not define the certification requirements, but is looking to see if the practice has them defined, documented, and are implementing them. The purpose of this evidence indicator is that there is additional experience and/or educational preparation in radiation oncology for all nurses (full or part-time).

    APEx requirements for certification and licensure are consistent with ASTRO’s Safety is No Accident publication. For all disciplines, the employee must either have the relevant professional certification or be eligible for certification. For any staff member who does not possess certification the facility must have a policy on the process for obtaining certification, with specific timelines for any individual working at the facility to become certified.
    Currently, APEx follows ASTRO's May 2011 publication “Medicare’s Physician Supervision Requirements.” The supervision requirements are different for hospital based locations and free standing facilities. If hospital based, you may assign other physicians or non-physician practitioners to supervise, however ASTRO does recommend this be a radiation oncologist.  In the freestanding setting a radiation oncologist must be "immediately available", meaning available on-site. If you meet the requirement for CMS, this would also meet the requirements for accreditation.

    Medicare’s Physician Supervision Requirements states that in a hospital based location “the supervising physician or non-physician practitioner must also be a person who is clinically appropriate to supervise the services or procedures.” The supervising physician or non-physician practitioner must be able to immediately step in and perform the procedure, not just in the event of an emergency, but to also be able to furnish assistance and direction throughout the performance of the procedure. CMS has indicated that the supervising physician or non-physician practitioner must also be a person who is “clinically appropriate” to supervise the services or procedures.  The non-radiation oncologist physician or a non-physician practitioner must have within his or her State scope of practice, licensure, training and hospital granted privileges the ability to perform the service or procedure, to meet the supervision requirements. It is ASTRO’s view that the radiation oncologist is always considered a clinically appropriate physician but there may be others who meet these requirements.

    Non-physician providers (physician extenders) include, but are not limited to, nurse practitioners, clinical nurse specialists, advanced practice nurses and physician assistants. The roles, qualifications, licensure requirements and maintenance of credentials for these individuals should be determined by their professional organization, scope of practice, rules and regulations of individual institutions and licensure regulations within individual jurisdictions. (See Safety Is No Accident, pages 11-12, section 2.2.3.)

    Standard 13 specifically addresses intra-disciplinary peer review. The minimum requirement is that radiation oncologists, physicists, therapists and dosimetrists have their own peer-to-peer review program. In order to be compliant, there must be an opportunity for staff to learn from other similarly qualified staff members (i.e. physicist-physicist, therapist-therapist, physician-physician). The form you choose (retrospective, current or prospective), what is reviewed and the frequency is up to the individual facility, but it must be documented as a standard operating procedure.
    Chart rounds may be used, but it is dependent on how the chart rounds is conducted at your facility. In order to be compliant, there must be a learning opportunity between similarly qualified staff members (i.e. physicist-physicist, therapist-therapist, physician-physician, dosimetrist-dosimetrist). If your chart rounds only consists of a single member of staff representing each discipline this would be classed as inter-disciplinary and would not be applicable for this particular standard. If your chart rounds contains multiple representation from the same profession, and allows the opportunity for their own work/decisions/techniques to be assessed by others of their own profession during the meeting, then it would be acceptable.
    APEx is assessing that a policy is in place that checks the relevant consent is current prior to commencing radiation treatment. The requirement is that the time from when the consent was signed by the patient until the first day of actual treatment is not more than 60 days. If there is a delay, and this time frame exceeds 60 days, the expectation is that a process exists to have the consent updated or redone prior to the first treatment.

  • APEx Surveyor FAQs

  • APEx surveyors must be:

    • A radiation oncology team member.
      • A U.S. licensed and board certified radiation oncologist and medical physicist
    • An ASTRO member. (If you are not a member, join now.)
    • An experienced professional with at least five years of U.S. radiation oncology experience post licensing.
    • Currently engaged in active practice.
    • Willing to survey exclusively for the ASTRO APEx program.
    • Willing to complete the required initial orientation and ongoing annual orientations.
    • Able to commit to one, one-day survey per quarter.
    Yes. If you are not already a member, you can apply for ASTRO membership as part of the surveyor application process.

    There are many benefits to becoming a surveyor for APEx. You will:

    • Play an essential role in promoting continuous quality improvement for the entire radiation oncology treatment team.
    • Refine your skills and knowledge as you observe your colleagues in different settings.
    • Find ways to refine and improve your own practice as you objectively review the procedures of other practices.
    • Receive annual orientation to stay current on the latest advancements and standards.
    • Receive an honorarium, and reimbursement of expenses incurred while you are performing a survey.
    • Be recognized as an official APEx surveyor.

    Complete the Surveyor Application. Your application will be reviewed by the APEx team. If you meet all of the qualification requirements and pass the orientation modules with a 70 percent score or higher, you can become an APEx surveyor.


    Yes. Surveyors receive an honorarium and expenses associated with the facility visit.

    Surveyors are selected to conduct a facility visit based on the following:

    • They have completed the surveyor training.
    • Their selected availability coincides with the survey date selected by the facility.
    • There is no conflict of interest with the facility.
    • The facility is located more than 200 miles from the surveyors’ institution.
    • The equipment and techniques at the facility match the experience of the surveyor.

    You can update your availability as often as you like, and are encouraged to do so. The system requires you select at least a day from the current quarter displayed.

    1. Go to the ASTRO surveyor portal.
    2. You will be prompted to log in to your MyAstro account.
    3. Click here to select your surveyor availability.

    If you are invited to perform facility visit you have 3 days to accept the offer. If accepted, you will participate in the given survey and ASTRO staff will be in contact. If you do not accept the offer within 3 days the system automatically rescinds the offer and it goes to the next potential surveyor.

    You may also decline the offer. You can decline for personal or professional reasons by selecting the decline button in the system.