No, the Self-Assessment Guide is proprietary information and is only shared with the ROPs once ASTRO has processed payment for the APEx program. You will have access to both the guide and the Self-Assessment as soon as your payment is processed.

APEx provides flexibility in the accreditation timeline so practices may choose the best option for them. APEx accreditation is valid for three or four years from the date of the ROP's APEx determination. This designation is made during the application process.

Each ROP’s time frame varies and is dependent on several things, such as the amount of time and staff dedicated to the accreditation process and what level of standardization and documentation is already in place.

Here are the four main phases of the APEx program and approximate time frames:

Application: Consists of general practice information, legal agreements and submission of payment.

• The ROP can complete the practice information in one day. The information consists of the name/address of the facility(s), key personnel, annual number of new patients treated, treatments offered, equipment information and physician(s).
• ASTRO suggests sending the legal agreements to legal representatives for review as soon as the ROP starts an application.
• From the time payment is posted by the practice until it clears the bank processing, it can take one to two weeks. ASTRO processes the payment in the APEx Portal as soon as it is received from the bank. After which the practice can gain access to program resources and start the Self-Assessment immediately.

Self-Assessment: Consists of an internal review by ROP staff to assess compliance with APEx Standards.

• Recently, ROPs seeking APEx accreditation have completed the Self-Assessment phase in an average of three months.
• The Document Uploads section require an external review once submitted. This usually takes between four to six weeks. ASTRO suggests uploading and submitting the document upload section first, then completing the Medical Record Review and Interview Preparation while the documents are under review.
• The Medical Record Review and Interview Preparation can be completed in one day and have instantaneous results, once submitted.

Facility Visit Prep: Consists of preparing for the facility visit, an objective external review by APEx Surveyors.

• Once the Self-Assessment is successfully completed, the ROP enters 15 preferred dates into the APEx Portal and may select dates that are between two and six months in advance. Facility visits are usually finalized within four weeks of submitting potential dates.
• A facility visit prep call will be held approximately two weeks prior to the scheduled facility visit date with representatives from the ROP to discuss the itinerary and review application information.

Determination: Consists of the final accreditation decision by ASTRO’s Practice Accreditation Subcommittee, based on the findings collected during the Facility Visit.

• The accreditation determination is communicated to the ROP between four to six weeks after the facility visit.

APEx follows ASTRO's 2018 Supervision Guidance. To meet the APEx requirement, a radiation oncologist should provide direct supervision, immediately available to provide assistance throughout the duration of the procedure. While APEx understands that a radiation oncologist may need to step away for a meeting or consultation with inpatients, a physician should be present at the facility to assure patient safety.

Exclusions may apply for facilities in rural exemption areas. Please contact APEx Support with any questions.

ROP representatives submit an online application through the APEx Portal. Find more information.

Please download the APEx Registration and Application Instructions before starting your application.

In order to qualify as a multi-facility practice, you need:

• Common policies and procedures of key evidence indicators
• An individual or committee from within radiation oncology practice leadership who is responsible for overseeing the operations of the multi-facility practice, including the culture of safety
• A medical director, who is a radiation oncologist, responsible for each facility
• All facilities located within a 50-mile radius of the main facility

Satellite facilities that are located within 50 miles of a main facility, and meet all satellite requirements, may be included in the application as part of a multi-facility practice; however the application will be placed on hold. Please contact ASTRO for further guidance. If accepted, there may be an additional fee of $3,000 for each satellite in this range. Satellite facilities located more than 150 miles from the main facility are required to do a separate application.

To make the APEx program scalable, ASTRO’s legal agreements must be used and ASTRO generally cannot accept changes to these agreements.

These prices are inclusive of all program-related expenses (e.g., program participation, surveyor travel costs) and is the only payment required throughout the accreditation cycle.

Yes, discounted rates are available for entities consisting of more than 10 active facilities within the APEx program. Once 10 facilities under the same ownership or affiliation have entered into facility agreements and submitted payment for the APEx program, ASTRO offers a discount of $2,000 off the price of any subsequent main facility applying for a 4-year APEx cycle. ROPs must notify ASTRO of their eligibility for the discount rate at APEx Support prior to submitting payment.

ASTRO currently has two options to submit payment for APEx.

1. The entire fee is paid during the application phase. If a practice chooses this option, there are no other costs associated with this accreditation process or during the four-year accreditation cycle.
2. Practices can take advantage of a partial payment option to reduce the upfront cost of the application fee. Half of the program fee is due during the application phase and the remaining balance is paid before scheduling the facility visit. The facility visit will not be scheduled until the balance has been paid.

A unique aspect of the APEx program is that ROPs must complete the Self-Assessment before scheduling a facility visit. The Self-Assessment is a self-study of the ROP’s compliance with the APEx Standards and is considered an essential component of the program. This process promotes quality improvement and leads to higher performance during the facility visit, as it allows the facility to set a baseline and implement changes or confirm their compliance with APEx Standards before the facility visit.

Level 1 evidence indicators are components that are essential to daily practice (e.g., informed consent, treatment machine QA) and, therefore, have a higher compliance requirement than Level 2 evidence indicators within the APEx program. All evidence indicators must be measured during the Self-Assessment and ROPs must demonstrate at least 85% compliance with Level 1 evidence indicators in each section of the Self-Assessment before being designated as ready for a facility visit.

Only the facility designated as the main facility will complete the Self-Assessment in a multi-facility application, as all facilities should follow the same policies and procedures. It is the responsibility of the ROP to disseminate program information to the satellite(s).

Although the Medical Record Review section of the Self-Assessment is completed using only the medical records from the main facility, the Document Upload section reflects the policies and procedures used throughout the entire ROP. Some information about the satellites will be required during Document Upload such as processes for treatment modalities performed only at a satellite location, staffing information and external validations of machine output.

Yes, you may choose up to 15 potential facility visit dates once the Self-Assessment is completed. The facility visit date is selected from those dates and is based on the availability of the required surveyors for each ROP.

Yes. The main facility will have an all-day facility visit, while each satellite location will have a half-day facility visit. All facility visits in a multi-facility practice occur on the same day.

No. It takes 4 to 6 weeks after the facility visit to receive an APEx accreditation determination.

The ASTRO Practice Accreditation Subcommittee is charged with issuing accreditation determinations based on the review of blinded facility reports from the facility visit. The committee is multi-disciplinary and includes radiation oncologists, medical physicists, radiation therapists and medical dosimetrists who are trained APEx surveyors.

There are three levels of accreditation that may be awarded:

1. Full accreditation
2. Provisional accreditation
3. Denial

No. A multi-facility practice will receive a single determination based on the lowest-performing facility.

Example: A multi-facility practice of four facilities applies for APEx accreditation. After the facility visit, three facilities receive full accreditation and one facility receives provisional accreditation. The entire multi-facility practice would be rewarded provisional accreditation.

ROPs that receive provisional accreditation must submit a corrective action plan (CAP) for low performing evidence indicators outlining how compliance will be achieved. CAPs are submitted and blinded before review by the Practice Accreditation Subcommittee. If the CAP is accepted, the ROP will receive full accreditation. If the ROP’s CAP is not accepted or not submitted within the required time frame, the ROP is denied accreditation.

An ROP has the right to appeal their decision based on specific criteria (see APEx Procedures for more information). The appeal request must be submitted to APEx Support within 30 days of the determination.

To avoid a lapse in your accreditation status, ASTRO recommends starting the reaccreditation process 12 months before the expiration of a current accreditation cycle. To initiate the process an APEx Portal Administrator for your ROP can click the Reaccreditation button on the Home tab of the APEx Portal to start the application.

During the application process, the ROP’s application is pre-populated with information from the initial accreditation application. While reviewing this information, the ROP can add/remove any satellites as required, as well as update each facility’s information (e.g., treatment modalities, physicians).

Someone within your ROP may have already initiated the application, which freezes the APEx Portal for all remaining team members. You will not have access to the APEx Portal until payment has been processed. At that time, your APEx Portal rights will be restored.

Yes. ROPs will begin by reviewing and submitting their application, legal agreements and payment to ASTRO. Once this is complete, the ROP will have access to the Reaccreditation Guide and the Self-Assessment phase of the program. Each main facility must complete the Self-Assessment to be deemed ready to schedule a facility visit.

Each ROP’s time frame varies and is dependent on several things, such as the amount of time and staff dedicated to the accreditation process and what level of standardization and documentation was retained from the initial accreditation process. The data shows that most practices going through reaccreditation with APEx complete the process faster than the initial process.

To avoid a lapse in your APEx accreditation status, the ROP should receive a reaccreditation determination before your current accreditation expires. Extensions of your accreditation status will be granted if 1) the facility visit is finalized before your expiration date and 2) the facility visit occurs within 90 days of your expiration date. Accreditation extensions are valid until a new determination is given.

Example: If an ROP’s accreditation is set to expire on March 31, an extension will be granted if a facility visit is finalized before March 31 and occurs before June 29.

APEx requires documentation of each component of 1.1, evaluated by the radiation oncologist, before simulation or any pre-treatment preparation. Items may be documented in initial consults, subsequent encounters and/or informed consent, if it occurs prior to simulation. Documentation must include one of the following for each component:

• Positive findings (e.g., allergic to contrast, previous radiation treatment).
• Pertinent negative (e.g., no known allergies, menopause 2002, no implantable cardiac device).
• Non-applicable references (e.g., lab results N/A).
• Confirmation of review (e.g., MRI Pelvis with contrast 3/27/15 reviewed).

APEx requires that a patient time out is performed before every treatment/procedure and verifies patient identification, correct treatment site, correct patient positioning and treatment parameters at the console. There are many ways this documentation may be evidenced (e.g., checklist, sign-off, daily alert acknowledgment).

The 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 a certification, the ROP must have a policy on the process for obtaining certification, with specific timelines for any individual to become certified, and supervision requirements, until Board certification is obtained

Patient Safety Organizations (PSOs):

• Share the goal of improving the quality and safety of health care delivery.
• Collect and analyze data to identify and reduce the risks and hazards associated with patient care.
• Create a secure, non-punitive environment through confidentiality and privilege protections.

The Radiation Oncology Incident Learning System, or RO-ILS, is a free patient safety initiative housed on Clarity PSO and created by ASTRO and AAPM, therefore meeting the requirement for 7.5.1. This program is dedicated to reducing medical errors by providing a platform for reporting safety events in a secure and non-punitive environment, gaining legal protection as afforded by the Patient Safety and Quality Improvement Act. There is no information shared between APEx and RO-ILS.

The requirement within APEx is an intra-disciplinary peer-to-peer review process for at least the radiation oncologists, medical physicists, radiation therapists and dosimetrists. 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). Information on peer review process for each professional group should include the form chosen (i.e., retrospective, current or prospective), what is reviewed, and the frequency of review.

In many instances, chart rounds are classed as intra-disciplinary for radiation oncologists, if there is more than one radiation oncologist in attendance, but would not be applicable for medical physicists, radiation therapists and dosimetrists.

To maintain a valid informed consent, APEx requires the informed consent to be signed 60 days before the first day of actual treatment. If there is a delay, and this time frame exceeds 60 days, the expectation is that the informed consent is updated or redone prior to treatment.

It is also compliant if the ROP has a documented formal policy showing a different time frame, such as 30 or 90 days.