Meet our ACRO Accreditation Team: Greg Madison, MS, FACRO

We're excited to introduce you to Greg Madison, MS, FACRO, one of our longtime ACRO Accreditation Physics Surveyors and a fellow of the College. In our interview, Greg shared his background, described the path which led him to medical physics, and shared advice about the ACRO Accreditation process. Greg is not only a surveyor, but also works as a physicist at Carl Larson Cancer Center (Beckley, WV), an ACRO-accredited practice:

Q: Please share your professional information and what led you to choose a career in the radiation oncology field.
GM: Graduated East Carolina University with a Master of Physics Degree in 1989 Clinical Medical Physics training at East Carolina University School of Medicine American Board of Radiology Certified, Diagnostic Physics American Board of Radiology Certified, Therapeutic Physics Fellow at the American College of Radiation Oncology While researching graduate level physics programs as an undergraduate, I came across a flyer for a new Medical Physics program at East Carolina University headed by Gordon Jendrasiak, PhD. Having no real understanding of the Medical Physics discipline, I contacted Dr. Jendrasiak to ask questions and learn the basic principles. Dr. Jendrasiak invited me to East Carolina University for an interview as a prospective Medical Physics graduate student and to observe the daily physics responsibilities in the radiation oncology department at East Carolina University School of Medicine. I was very intrigued by the program and chose Medical Physics as my career.

Q: How did you become involved with the ACRO Accreditation program?
GM: I was employed in a small private practice radiation oncology center. We were initially seeking a method that would make our clinic stand out among our competing radiation oncology facilities. In 1998, the American College of Radiation Oncology (ACRO) was a fledgling peer review accreditation program. We felt that submitting our practice to the voluntary peer review and achieving accreditation, we could use the accreditation as badge of honor to raise us above our competition. We continued to renew our ACRO accreditation seal from that point on. In 2009, I was contacted by Ishmael Parsai, PhD, who was the Director of Physics for ACRO. He invited me to join the ACRO team as a physics site surveyor.

Q: What do you like best about working as a surveyor?
GM: I have been a solo practicing medical physicist for most of my career. As a surveyor, I have interacted with numerous large and small radiation oncology facilities. This has allowed me to build an extensive network of contacts to seek advice on new technologies I may be able to use in my practice. In addition, I have been able to enhance and make more efficient, a number of my routine quality assurance procedures by observing how other facilities perform the same quality assurance procedure. Finally, and more importantly, I have had occasion to make recommendations on a site visit report where the site physicist expresses their appreciation for the recommendation and acknowledges how the recommendation has helped them enhance their program to the benefit of their patients.

Q: Why do you think accreditation is important for practices?
GM: There is a vast amount of literature published each year regarding the ever-increasing technology of radiation oncology. With increasing technology, there will always be the need for increased quality assurance testing by medical physicists. It is virtually impossible for each facility to read every publication that may improve their radiation oncology practice. Through the ACRO Accreditation Manual and certification process, ACRO provides a firm base on the minimal program requirements which ensures a high-quality practice. ACRO has been firmly committed to updating the manual nearly every year to further improve the accreditation process. Although many of our patients are unaware of the effort required to maintain an accredited status, many of them recognize our status as Accredited by the American College of Radiation Oncology as an achievement not held by other radiation oncology facilities in our area.

Q: What are some tips you would share with practices going through accreditation?
GM: There are many high-quality facilities across the country. In my experience, most of them are performing many of the necessary quality assurance tests required to achieve ACRO accreditation status however documentation of these tests may not be complete. Detailed documents are essential to demonstrate a well-functioning radiation oncology practice.

Staying current with medical physics publications is also key. Due to the vast amount of literature available, I recommend following the Medical Physics Practice Guideline reports as they are updated more frequently than the Task Group Reports.

Next, be very familiar with the ACRO Accreditation Manual. The manual contains vast amounts of useful information to help in the accreditation process.

Finally, use the final report’s Required Corrective Actions and Recommendations constructively. There are many improvements that can result from a peer-to-peer review process. I have had my facility ACRO accredited since 1998 and I have been an active site reviewer since 2009 yet I am still able to improve my practice by utilizing the Required Corrective Actions and Recommendations each and every cycle.

Q: What do you think differentiates the ACRO Accreditation program from other accrediting programs?
GM: My facility has always sought the ACRO accreditation, however, for a stretch of six years, we also carried the ACR accreditation due to local Veteran’s Hospital contract requirement. The American College of Radiology has a vast amount of literature listed in their Quality Control and Quality Assurance: Radiation Oncology website. Most of the ACR quality assurance and control literature references coincide with the same references used by ACRO. Having carried both ACRO and ACR accreditations simultaneously for a number of years, I have found both to be very useful in maintaining a high quality radiation oncology practice. When our local VA Medical Center removed the contract requirements for ACR accreditation, I was asked by our administration to choose which accreditation to keep and which to drop. I choose to keep the ACRO accreditation for two primary reasons.

First, the ACR accreditation involves one physicist and one physician to review the clinical aspects of the practice. Although the ACR physician and physicist site reviewers are very thorough in their respective areas of expertise, there is no review of the administrative practices. ACRO includes the administrative peer review as an integral part of the accreditation process. This includes patient care, patient safety, staffing, equipment cleaning procedures and review of policy and procedures, just to name a few. Over the decades, I have found the administrative review to be just as useful as the physics and physician peer review.

Second, upon the arrival of the ACR site reviewers, an in-brief is offered after which, the physician and physicist will sequester themselves behind closed doors for the duration of the review process using pre-selected patient medical records. There is no opportunity for the site physician or physicist to interact with or answer questions during the review process. ACRO conducts the site reviews in a one-on-one format so that there is full interaction between the facility and the reviewers from start to finish. In this way, conversations can be held so that the site reviewer can question a document or procedure and is able to accurately conclude whether the accreditation requirement is fulfilled. I find this very useful because there are no two practices that are identical, therefore, fully understanding the methods used by the facility can only be realized by one-on-one interactions.