ASTRO APEx is the American Society for Radiation Oncology's Accreditation Program for Excellence, a review of a radiation oncology practice's safety and quality against the APEx Standards, with a self-assessment, a facility visit and a decision by ASTRO. This service is for radiation oncology practice and department administrators preparing for APEx. Integral Healthcare Solutions (IHS) organizes the quality-management documents and evidence for APEx; your physicians and physicists own every technical and clinical standard.

Last reviewed: October 2026. ASTRO APEx pages and procedures checked on October 2, 2026.

What is ASTRO APEx accreditation?

The governing text is ASTRO's APEx - Accreditation Program for Excellence: APEx Standards Guide, applied under the 2024 APEx Accreditation Procedures (ASTRO procedures PDF). ASTRO describes the program this way: "The APEx process offers a transparent, measurable and consensus-based evaluation of a radiation oncology practice's adherence to safety and quality standards. It begins with an internal self-assessment, enabling facility staff to gauge their compliance with APEx Standards before the facility visit" (About APEx).

On where the standards come from, ASTRO states: "APEx Standards and evidence indicators are derived from radiation oncology white papers and consensus guidance, including Safety is No Accident and AAPM reports" (About APEx).

The full Standards Guide is not public. ASTRO's FAQ says: "the Standards Guide is proprietary information and is only shared with the radiation oncology practice after payment is processed. However, there is an abridged copy available publicly" (APEx application process). The abridged copy (PDF dated December 2023, modified May 2024) lists Standards 1 through 14, including Standard 1, Patient Evaluation, Care Coordination and Follow-up; Standard 12, Quality Management of Treatment Procedures and Modalities; and Standard 13, Peer Review of Clinical Processes (APEx Standards, abridged). ASTRO's Standards Guide may have been revised since this abridged copy; your practice's full guide controls. IHS works from the full guide your practice receives after registering.

ASTRO lists four steps:

1. Register. "Single facilities and multi-facility practices are eligible."
2. Self-Assessment. "Your team evaluates your practice against APEx Standards across five domains: process of care, team, safety, quality management, and patient-centered care."
3. Facility Visit. "A surveyor team conducts an in-person or virtual evaluation."
4. Accreditation Decision. "ASTRO's Practice Accreditation Subcommittee issues a determination within four to six weeks of your facility visit. Accreditation runs on a three- or four-year cycle, depending on your preference."

Source for all four steps: APEx application process. On timing, ASTRO's FAQ says: "Generally, APEx should take ten to twelve months," and "Practices have six months to complete the Self-Assessment, but most practices finish in two months. The Document Uploads section requires an external review once submitted, which takes between four to six weeks" (APEx FAQ).

Who needs it and what triggers it

APEx is open to radiation oncology practices that fit ASTRO's definition: "an ROP is defined as a medical practice offering radiation therapy services, using the services of interdisciplinary professionals under the direction of a board-certified radiation oncologist. Currently, only practices located in the U.S. or in a U.S. territory are eligible to apply for accreditation" (ASTRO procedures).

Practices come to this work in three situations:

• A practice seeking APEx for the first time, as a single facility or a multi-facility practice.
• An accredited practice approaching the end of its three- or four-year cycle. ASTRO grants extensions when "the facility visit is scheduled prior to the expiration date, and the facility visit occurs within 90 days of the expiration date" (ASTRO procedures).
• A practice adding radiopharmaceutical therapy accreditation, which ASTRO offers integrated with an existing APEx accreditation or as a standalone option.

On regulatory acceptance, ASTRO's FAQ states: "APEx is accepted throughout the U.S. and is recognized by all state regulations where applicable" (APEx FAQ). That is ASTRO's statement. This page makes no claim about payer or state requirements.

How IHS helps

IHS organizes the quality-management documents and evidence for APEx; your physicians and physicists own every technical and clinical standard. The work follows IHS's standard accreditation process:

1. Gap assessment: IHS reviews the practice's existing documentation against the APEx Standards, using the full Standards Guide your practice receives after registering.
2. Questionnaires: Short questionnaires to your team on care team roles, document control, quality review, peer review and patient feedback.
3. Evidence crosswalk: A map from each standard and evidence indicator to the document the practice will upload in the Self-Assessment.
4. Drafting: IHS drafts administrative and quality-management policies and responsibility maps. Clinical and physics procedures are written or approved by your radiation oncologists and physicists.
5. Mock document review: Before the Document Uploads are submitted, IHS reviews the upload set the way an outside reviewer would and lists what to fix.
6. Readiness support: Help preparing staff and records for the facility visit, organized by the five APEx domains.

What your practice supplies: the APEx Standards Guide, existing procedures, QA records, and time from your radiation oncologists, physicists and dosimetrists. Your practice registers with ASTRO and submits everything itself.

The limit: treatment planning, dosimetry and physics QA are technical judgments IHS does not make or review. IHS covers the organizational and documentation layer.

What to have ready

These are the items the APEx materials point to:

• A decision on how you will register: single facility or multi-facility practice, with each main and satellite facility listed (APEx application process).
• The full APEx Standards Guide, which ASTRO releases after payment is processed (APEx FAQ).
• Current state and federal licenses and certifications, including Nuclear Regulatory Commission requirements. The 2024 procedures state: "Applicants must also meet applicable state and federal licensure and certification requirements, including those of the Nuclear Regulatory Commission" (ASTRO procedures).
• Documentation that services run under the direction of a board-certified radiation oncologist, per the 2024 procedures' definition of a radiation oncology practice (ASTRO procedures).
• Coverage schedules and a supervision policy that address ASTRO's FAQ answer: "A radiation oncologist must provide direct supervision, immediately available to provide assistance throughout the duration of procedures. 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." (APEx FAQ).
• Patient evaluation, care coordination and follow-up procedures (Standard 1 in the abridged APEx Standards, 2023-12 PDF).
• Quality management records for treatment procedures and modalities, including QA records (Standard 12, abridged APEx Standards).
• Peer review records for clinical processes (Standard 13, abridged APEx Standards).
• A named owner for each of the five Self-Assessment domains: process of care, team, safety, quality management, and patient-centered care (APEx application process).
• A calendar that fits ASTRO's six-month Self-Assessment window and the four- to six-week external review of Document Uploads (APEx FAQ).
• For reaccreditation, your current expiration date, so the facility visit can be scheduled before it (ASTRO procedures).

If you want to walk through this list against your practice's documents, the introductory call is the place to start.

How it compares

The options practices ask about:

The ACR article is dated 2021; check current ACR materials. Which program fits depends on your practice, your payers and your state.

What it costs

ASTRO publishes APEx pricing (APEx application process, read October 2, 2026):

• Radiopharmaceutical therapy accreditation: $1,000 integrated with an existing APEx accreditation, or $5,000 standalone.
• In-person facility visit: ASTRO's table lists "$2,000 Main | $1,000 Satellite" for an in-person visit. Its footnote says: "All initial accreditation facility visits will be in person for no additional fee. For reaccreditation, APEx continues to provide practices the option between in-person and virtual facility visits. The in-person format will now include a fee to help offset increased travel costs." So the in-person fee applies to reaccreditation visits, not initial ones. "Additional Distance" is $3,000, and ASTRO's note says that for in-person visits "some locations may incur a $3,000 fee per satellite depending on distance."
• Multi-facility discount: "After your organization has 10 facilities enrolled with signed agreements and paid fees, we offer a $2,000 discount on each additional main facility that joins for a full four-year APEx cycle."

Verify current fees with ASTRO. IHS scopes each engagement after a free introductory call.

What this is not

• IHS is not ASTRO and does not grant, predict or influence an accreditation decision.
• IHS does not register, submit or speak for your practice with ASTRO. IHS drafts; your practice submits.
• IHS does not make or review treatment planning, dosimetry or physics QA decisions, and this page is not legal, clinical or physics advice.

Frequently asked questions

What is ASTRO APEx accreditation, and how does it differ from other radiation oncology accreditation?

APEx (Accreditation Program for Excellence) is the American Society for Radiation Oncology's practice accreditation program. ASTRO describes it as an evaluation of a radiation oncology practice's adherence to safety and quality standards that begins with an internal self-assessment, followed by a facility visit. ASTRO says its standards and evidence indicators are derived from radiation oncology white papers and consensus guidance, including Safety is No Accident and AAPM reports. The ACR runs a separate radiation oncology practice accreditation with an on-site survey.

Who is eligible for APEx?

ASTRO states that single facilities and multi-facility practices are eligible. Its procedures define a radiation oncology practice as a medical practice offering radiation therapy services through interdisciplinary professionals under the direction of a board-certified radiation oncologist, and limit eligibility to practices located in the U.S. or a U.S. territory.

How long does APEx accreditation take from registration to decision?

ASTRO says APEx generally takes ten to twelve months. Practices have six months to complete the Self-Assessment, and ASTRO says most finish in two; the Document Uploads then go to an external review that takes four to six weeks. A decision follows within four to six weeks of the facility visit.

How much does APEx accreditation cost?

ASTRO's published pricing lists a main facility at $9,500 for a three-year cycle or $13,000 for a four-year cycle, and a satellite facility at $3,000 or $4,000. Radiopharmaceutical therapy accreditation is $1,000 added to an existing APEx accreditation or $5,000 standalone. Verify current fees with ASTRO.

Can we see the APEx Standards before applying?

Only in abridged form. ASTRO states that the Standards Guide is proprietary and is shared with the practice only after payment is processed, and that an abridged copy is available publicly. The public copy lists Standards 1 through 14.

What happens in the APEx Self-Assessment?

ASTRO says your team evaluates the practice against the APEx Standards across five domains: process of care, team, safety, quality management, and patient-centered care. The Self-Assessment includes a Document Uploads section, which goes to an external review once submitted.

Is the APEx facility visit in person or virtual?

ASTRO says a surveyor team conducts an in-person or virtual evaluation. ASTRO's pricing page says initial accreditation visits are in person.

What radiation oncologist supervision does APEx require?

ASTRO's FAQ states that a radiation oncologist must provide direct supervision, immediately available to provide assistance throughout the duration of procedures. It adds: "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." If your practice needs an exclusion determination, IHS drafts the question and your practice sends it to APEx Support.

Does APEx satisfy state or payer requirements for accreditation?

ASTRO states that APEx is accepted throughout the U.S. and is recognized by all state regulations where applicable. That is ASTRO's own claim. IHS did not review a payer or state source on whether practice accreditation is required, so confirm your own payer and state requirements directly.

How does APEx reaccreditation work, and how do we avoid a lapse?

Accreditation runs on a three- or four-year cycle, chosen by the practice. ASTRO's procedures grant an extension when the facility visit is scheduled before the expiration date and occurs within 90 days of it.