Table 5.

Clinical standards.

Category	Standard
Referral for treatment/treatment decision/treatment indications	1. Institution's patients shall be subjected to medical exposure for diagnostic or therapeutic purposes, only on recommendation of a medical practitioner. 2. Examination or treatment involving ionizing radiation require a written referral issued by a practitioner authorized to prescribe examination or treatment involving ionizing radiation. 3. Examinations involving ionizing radiation shall be made without doctor's referral only under medical screening projects. 4. Decision on radiotherapy shall be made on the basis of a patient interview, assessment of patient's health and psychosocial status, results of physical and pathological examination results, assessed stage of cancer advancement, and patient's medical documentation. 5. Results of diagnostic tests shall form an integral part of patient's medical documentation and remain available before, during and after treatment. 6. The institution shall evaluate patient's psychosocial condition and accordingly adjust its health care and treatment options. 7. Referral for radiotherapy shall be made in writing and duly authorized (by signature, stamp and date) by a medical practitioner specializing in oncological radiotherapy. 8. Recommendation for radiotherapy shall include planning target volume, gross tumor volume and clinical target volume (PTV, GTV, CTV) according to the rules provided ICRU 50, ICRU 62, and ICRU 38 reports, total dose, method of fractioning, total duration of therapy, planned intervals, and description of treatment techniques pursuant to an applicable therapeutic protocol. 9. Recommendation for radiotherapy shall be forwarded to the team responsible for therapy planning (medical physicist, dosimetrist, radiation technologist) who do the necessary calculations and planning. 10. The institution holds treatment waiting lists.
Therapeutic protocol	1. The institution has established, implemented and documented a therapeutic protocol describing a treatment pattern for each type therapy, tumor location and disease. 2. The therapeutic protocol shall be consistent with the national model of clinical procedures and based on confirmed results of clinical, radiological or physical tests. 3. The institution has indicated sources of the clinical standards it applies (own guidelines, national or international guidelines, etc.). 4. Patients shall be treated in accordance with the established therapeutic protocol; any exemptions need to be accounted for and reasons recorded in patient's medical documentation (e.g. irradiation sheet). 5. Each therapeutic protocol shall provide for lowest possible exposure of healthy tissues (ALARA) and protection of healthy tissues wherever practicable and justified. 6. The institution has implemented and documented a therapeutic protocol for radiotherapy of pregnant women pursuant to national regulations. 7. Therapeutic protocols shall be systematically reviewed and updated to keep in pace with the progress in medical and clinical knowledge. 8. The institution shall hold regular meetings to review therapeutic protocols.