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APEx is truly dedicated to the unique structure and challenges of radiation oncology. It stands out as the designated source of external quality standards for a radiation oncology department. As we attempt to proactively build a metric-driven quality program in our department, APEx standards provide the most accessible backbone.
— Brandon Weiss, RT(T), Quality and Safety Manager -
Radiation Oncology, Allegheny Health Network



Am I able to access the Standards Guide before applying for the APEx program?

No, the Standards Guide is proprietary information and is only shared with the radiation oncology practice after payment is processed.

How long does APEx Accreditation last?

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 practice's APEx determination. This choice is made during the application process.

What is a typical time frame to complete APEx ?

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.

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

Application: Consists of general practice information, legal agreements and submission of payment. ASTRO suggests sending the legal agreements to legal representatives for review as soon as the ROP starts an application. The practice information can be completed in one day.

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

  • Practices have completed the Self-Assessment in an average of three months.
  • The Document Uploads section requires an external review once submitted, which takes between four to six weeks.
  • The Medical Record Review and Physics Checklist can be completed in one day and provide instantaneous results.

Facility Visit Prep: Consists of preparing for the facility visit. Facility visits are usually finalized within four weeks.

Determination: Consists of the final accreditation decision, made 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.

What are the APEx requirements for radiation oncologist supervision?

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.

Does APEx meet regulatory requirements for accreditation?

Yes, APEx is accepted throughout the U.S. and is recognized by all state regulations where applicable.

Does the VA recognize APEx as an accrediting body for radiation oncology practices?

Yes, the U.S. Department of Veterans Affairs accepts APEx as an accrediting body for community-based facilities that treat veterans in the absence of a VA medical center.

Transitioning To APEx

We are already accredited but are considering transitioning to APEx. What should we know?

Unique Qualities of APEx: Key Highlights Explored provides an overview of what sets APEx apart from other accreditation programs. The document highlights distinctive APEx requirements, such as the culture of safety, intradisciplinary peer review for all professions and patient education/referrals. This document can help your practice make an informed accreditation decision.

I want to speak to my practice about APEx. Does ASTRO have any materials I can use?

ASTRO has created a library of presentation slides called Transitioning to APEx Accreditation that you can customize depending on your audience (e.g., administration, physics, etc.). These slides will help you effectively communicate the advantages of APEx to your team and address any questions they may have.

We want to hear from other radiation oncology professionals. Can ASTRO provide our practice with the chance to talk to an APEx-accredited facility?

Hearing from colleagues who have completed the APEx process can provide valuable insights. You can request a teleconference with a knowledgeable radiation oncology professional from your chosen discipline by completing the peer-to-peer request form. This meeting will allow you to ask specific questions and learn from their experiences.



Why is the Self-Assessment necessary?

TheAPEx Self-Assessment is a unique aspect of APEx. The Self-Assessment is a self-study of the practice's compliance with the APEx Standards and is considered an essential component of the program. This process helps practices identify deficiencies and promotes quality improvement. This activity 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.

Who completes the Self-Assessment in a multi-facility practice?

The Self-Assessment is conducted by the main facility in a mulit-facility practice. Some information will be required from any satellite locations if they treat with unique techniques not found at the main facility.


Facility Visits and Determinations

Do I get to choose my facility visit date?

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 based on the availability of the surveyors.

Does each facility in a multi-facility practice have its own facility visit?

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.

Will I know my determination at the end of the facility visit?

No, determinations are not made during the facility visit. It takes four to six weeks after the facility visit to receive an APEx accreditation determination.

Who decides if my practice earns APEx accreditation?

ASTRO's  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.

Practices may receive one of three accreditation determinations:

  1. Full accreditation
  2. Provisional accreditation
  3. Denial
Does each facility in a multi-facility practice get their own determination?

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. After the facility visit, three facilities receive full accreditation and one facility receives provisional accreditation. The entire multi-facility practice would be awarded provisional accreditation.

What happens if we receive a provisional determination?

Practices 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 practice will receive full accreditation. If the practice's CAP is not accepted or not submitted within the required time frame, the ROP is denied accreditation.

What if we want to appeal our determination?

A practice 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.


APEx Reaccreditation

When can I start reaccreditation?

To avoid a lapse in your accreditation status, ASTRO recommends starting the reaccreditation process 12 months before the expiration of a current accreditation cycle. 

How can we remove/add satellite facilities to our reaccreditation application?

During the application process, the practice's application is prepopulated with information from the initial accreditation application. While reviewing this information, the practice can add/remove any satellites as require. Practices should also use this time to update each facility’s information (e.g., treatment modalities, physicians).

Why can't I click the resume button in the APEx Portal?

Someone within your practice may have already initiated the application, which locks out additional staff from the APEx Portal until payment has been processed. At that time, your APEx Portal rights will be restored.

Is the reaccreditation process the same as the initial process?

The practice will begin by reviewing and submitting their application, legal agreements and payment to ASTRO. Once this is complete, the practice will gain access to the Self-Assessment and facility resources. Each main facility must complete the Self-Assessment to be deemed ready to schedule a facility visit.

Are there any time frames associated with the reaccreditation process?

A practice's time frames vary and are 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.

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