Current status of kilovoltage (kV) radiotherapy in the UK: installed equipment, clinical workload, physics quality control and radiation dosimetry

Abstract

Objective: To assess the status and practice of kilovoltage (kV) radiotherapy in the UK. Methods: 96% of the radiotherapy centres in the UK responded to a comprehensive survey. An analysis of the installed equipment base, patient numbers, clinical treatment sites, quality control (QC) testing and radiation dosimetry processes were undertaken. Results: 73% of UK centres have at least one kV treatment unit, with 58 units installed across the UK. Although 35% of units are over 10 years old, 39% units have been installed in the last 5 years. Approximately 6000 patients are treated with kV units in the UK each year, the most common site (44%) being basal cell carcinoma. A benchmark of QC practice in the UK is presented, against which individual centres can compare their procedures, frequency of testing and acceptable tolerance values. We propose the use of internal "notification" and "suspension" levels for analysis. All surveyed centres were using recommended Codes of Practice for kV dosimetry in the UK; approximately the same number using in-air and in-water methodologies for medium energy, with two-thirds of all centres citing "clinical relevance" as the reason for choice of code. 64% of centres had hosted an external dosimetry audit within the last 3 years, with only one centre never being independently audited. The majority of centres use locally measured applicator factors and published backscatter factors for treatments. Monitor unit calculations are performed using software in only 36% of centres. Conclusion: A comprehensive review of current kV practice in the UK is presented. Advances in knowledge: Data and discussion on contemporary kV radiotherapy in the UK, with a particular focus on physics aspects.

Phase I/II study on kilovoltage surface brachytherapy in conjunctival cancer: preliminary results

“…The use of kilovoltage allows for a more predictable dosimetry compared to radioactive isotopes and eliminates the unnecessary exposure of patients and health personnel to ionising radiation. To date, our Institution has replaced the use of isotopes for surface treatment, in line with the international trend towards migration to more secure systems of treatment, which allow for versatility in pathology management of other anatomical regions [ 15 ].…”

A snapshot of medical physics practice patterns

“…Surveys have been a useful tool in understanding and documenting the standard‐of‐care in various topics in radiotherapy physics . Over the past 5 yr, there have been over 250 surveys distributed mainly through the medical physics listserv covering varying topics of interest to clinical physicists (e.g., simulation practices, use of image guidance, and clinical workflow).…”

Kilovoltage therapy is well and truly alive and needed in a modern radiotherapy centre

“…A survey of practice in the UK from 2015 found that 27% of centres had no kilovoltage unit [20]. The main reasons given for this absence was the use of electrons or HDR brachytherapy instead, and insufficient patient numbers.…”