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APEx Standards

Snueel Nagda
"In an ever-advancing landscape of radiation therapy delivery, contemporary practices need an accreditation process that facilitates implementing these advances in the safest, most streamlined and highest quality manner. APEx provides the tools and framework to do this seamlessly." 

— Gopal Bajaj, MD, MBA, FASTRO

APEx and its Standards were designed using the consensus report Safety is No Accident: A Framework for Quality Radiation Oncology Care. The 14 APEx Standards are organized around these five concepts:

The Process of Care

The “Process of Care” in radiation oncology refers to a conceptual framework for delivering appropriate, high-quality and safe radiation therapy treatment. Use of ionizing radiation in medical treatment requires direct or personal physician management as the radiation oncology team leader, with input from other essential coworkers. These Standards derive from the model Process of Care flow diagram in the consensus report Safety is No Accident: A Framework for Quality Radiation Oncology Care.

  • Standard 1: Patient Evaluation, Care Coordination and Follow-up
  • Standard 2: Treatment Planning
  • Standard 3: Patient-specific Safety Interventions and Safe Practices in Treatment Preparation and Delivery

The radiation oncology team

The radiation oncology team works to provide every patient undergoing radiation treatment the appropriate level of medical, emotional and psychological care before, during and after treatment through a collaborative multidisciplinary approach. The primary radiation oncology team consists of, but is not limited to, radiation oncologists, medical physicists, medical dosimetrists, oncology nurses and radiation therapists.

  • Standard 4: Staff Roles and Responsibilities
  • Standard 5: Qualifications and Ongoing Staff Training
  • Standard 6: Safe Staffing Plan


The radiation oncology practice creates an interdisciplinary team-based culture that continuously reviews, monitors and adapts all aspects of safety.

  • Standard 7: Culture of Safety
  • Standard 8: Radiation Safety
  • Standard 9: Emergency Preparation and Planning

Quality management

The radiation oncology practice has a quality management program that includes the facility, equipment, information management, treatment procedures and modalities, and peer review.

  • Standard 10: Facility and Equipment
  • Standard 11: Information Management and Integration of Systems
  • Standard 12: Quality Management of Treatment Procedures and Modalities
  • Standard 13: Peer Review of Clinical Processes

Patient-centered care

ASTRO’s patient-centered care standards aim to make care safer by promoting effective communication, coordination of care and engaging patients and families as partners in care. These priorities are reflected in the APEx Standards and evaluation criteria specific to the practice of radiation oncology.

  • Standard 14: Patient Education and Health Management
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