BQUATRO audits in radiotherapy: Crossperspectives between auditors and audited departments.

Since 2011, the Belgian College of Physicians for Radiation Oncology has implemented a national program of peer-reviewed clinical audits in radiotherapy departments, aiming to enhance quality practices, safety culture, and promote professional experience sharing. This article summarizes the theoretical and practical aspects of this peer audit process providing cross-perspectives of auditors and audited departments. National audits have been carried out using the BQUATRO methodology and framework whereby radiotherapy departments are audited every 5 to 6 years. The audit is carried out by a multidisciplinary team of clinically active radiotherapy professionals. Peer reviewed clinical audits have been carried out in Belgium since 2010 resulting in all radiotherapy departments having been audited at least twice. Audits have helped reinforce team engagement, highlight often-underestimated strengths, and structure continuous improvement initiatives. Auditors have also developed crossfunctional expertise and a better understanding of organizational challenges. The BQUATRO peer-reviewed clinical audit differs from traditional regulatory approaches by its collaborative and constructive posture. It promotes organizational learning and practice alignment among Belgian radiotherapy departments. The peer-reviewed clinical audit process is a strategic lever for improving quality of care in Belgian radiotherapy. Its sustainability and expansion to other countries represent key improvement opportunities for radiotherapy centres.