Comprehensive QA for radiation oncology: Report of AAPM Radiation Therapy Committee Task Group 40

The major errors in HDR procedures were failures to enter the correct treatment distance, which could be caused by either entering wrong transmission lengths or imprecisely digitizing the dwelling positions. Most of those errors were not easily avoidable by enhancing the HDR management level because they were caused by implementations of nonstandardized applicators utilizing transmission tubes of different lengths in standard HDR procedures. We performed this comprehensive study to include all possible situations with different nonstandardized applicators that frequently occurred in HDR procedures, provide corresponding situations with standard applicator as comparisons, list all possible errors and in planning, clarify the confusions in offsets setting, and provide mathematical and quantitative solutions for each given scenarios. Training on HDR procedures with nonstandardized applicators are normally not included in most residential program for medical physics, thus this study could be meaningful in both clinical and educational purpose. At precision of 1 mm, our study could be used as the essential and practical reference for finding the correct treatment length as well as locating the accurate dwelling positions in any HDR procedure with nonstandardized applicators.

Section: Practical Approachmentioning

confidence: 99%

A review of nonstandardized applicators digitization in Nucletron™ HDR procedures

Wang

Ferenci

Zerda

et al. 2017

“…Of these patients, more than 10% are either overexposed or underexposed due to lack of proper equipment, personnel skill or training (12) . In order to circumvent these problems and achieve the required level of accuracy (as stated earlier) and maintain consistency, a continued and comprehensive quality assurance (QA) of each step of radiotherapy is essential according the international guidelines 13 , 14 , 15 . However, an independent external quality audit along with the local QA program is also recognized as a part of an effective method of checking the quality and accuracy in radiation dose delivery to the patients (8) .…”

Section: Introductionmentioning

confidence: 99%

Assessment of national dosimetry quality audits results for teletherapy machines from 1989 to 2015

Muhammad

Ullah

Mahmood

et al. 2016

The purpose of this study was to ensure accuracy in radiation dose delivery, external dosimetry quality audit has an equal importance with routine dosimetry performed at clinics. To do so, dosimetry quality audit was organized by the Secondary Standard Dosimetry Laboratory (SSDL) of Pakistan Institute of Nuclear Science and Technology (PINSTECH) at the national level to investigate and minimize uncertainties involved in the measurement of absorbed dose, and to improve the accuracy of dose measurement at different radiotherapy hospitals. A total of 181 dosimetry quality audits (i.e., 102 of Co‐60 and 79 of linear accelerators) for teletherapy units installed at 22 different sites were performed from 1989 to 2015. The percent deviation between users’ calculated/stated dose and evaluated dose (in the result of on‐site dosimetry visits) were calculated and the results were analyzed with respect to the limits of ±2.5% (ICRU “optimal model”) ±3.0% (IAEA on‐site dosimetry visits limit) and ±5.0% (ICRU minimal or “lowest acceptable” model). The results showed that out of 181 total on‐site dosimetry visits, 20.44%, 16.02%, and 4.42% were out of acceptable limits of ±2.5%±3.0%, and ±5.0%, respectively. The importance of a proper ongoing quality assurance program, recommendations of the followed protocols, and properly calibrated thermometers, pressure gauges, and humidity meters at radiotherapy hospitals are essential in maintaining consistency and uniformity of absorbed dose measurements for precision in dose delivery.PACS number(s): 87.50.cm, 87.50.sj, 87.50.up, 87.50.wj, 87.50.yk, 87.55.km, 87.55.Qr

“…Changes in practice must be based on a careful assessment of the needs of that change, as well as understanding of the causes that could lead to treatment errors (19) . The PSRS in conjunction with CQI programs provide an excellent mechanism from which to evaluate, present, and drive valid changes in practice centered around improving the safety and efficacy of patient treatment 20 , 21 , 22 . In general, naming conventions can help practitioners cope with the ever expanding levels of sophistication of modern treatment simulation, planning, and delivery systems, and increase the safety culture of a clinic 7 , 22 , 23 , 24 …”

Section: Introductionmentioning

confidence: 99%

Guidelines for treatment naming in radiation oncology

Denton¹,

Shields

Hahl

et al. 2015

Safety concerns may arise from a lack of standardization and ambiguity during the treatment planning and delivery process in radiation therapy. A standardized target and organ‐at‐risk naming convention in radiation therapy was developed by a task force comprised of several Radiation Oncology Societies. We present a nested‐survey approach in a community setting to determine the methodology for radiation oncology departments to standardize their practice. Our Institution's continuous quality improvement (CQI) committee recognized that, due to growth from one to three centers, significant variability existed within plan parameters specific to patients’ treatment. A multidiscipline, multiclinical site consortium was established to create a guideline for standard naming. Input was gathered using anonymous, electronic surveys from physicians, physicists, dosimetrists, chief therapists, and nurse managers. Surveys consisted of several primary areas of interest: anatomical sites, course naming, treatment plan naming, and treatment field naming. Additional concepts included capitalization, specification of laterality, course naming in the event of multiple sites being treated within the same course of treatment, primary versus boost planning, the use of bolus, revisions for plans, image‐guidance field naming, forbidden characters, and standard units for commonly used physical quantities in radiation oncology practice. Guidelines for standard treatment naming were developed that could be readily adopted. This multidisciplinary study provides a clear, straightforward, and easily implemented protocol for the radiotherapy treatment process. Standard nomenclature facilitates the safe means of communication between team members in radiation oncology. The guidelines presented in this work serve as a model for radiation oncology clinics to standardize their practices.PACS number(s): 87.56.bd, 87.56.Fc, 87.55.Qr, 87.55.‐x, 87.55.N‐, 87.55.T‐, 87.55.D‐