Physical Aspects of Quality Assurance in Radiation Therapy

Svensson, Göran K.; Baily, Norman A.; Loevinger, Robert; Morton, R. J.; Moyer, Robert F.; Purdy, James A.; Shalek, Robert J.; Wootton, P.; Wright, K. A.; Hanson, W. F.; Anderson, Lowell L.; Ling, C. Clifton; Strubler, K.; Feldman, Arnold S.; Jones, Douglas T.; Karzmark, C. J.; McCullough, Edwin C.; Suntharalingam, N.

doi:10.37206/12

Cited by 54 publications

(14 citation statements)

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“…For example, X‐ray output constancy of 2% or better is recommended, so that a dose deviation of 1% observed under gated operation is well within acceptable limits. Similarly, a 0.7% dose profile deviation at the central axes is well within 2% flatness (defined in TG‐24 (35) ) requirements.…”

Section: Discussionsupporting

confidence: 67%

Dosimetric characteristics of a new linear accelerator under gated operation

Kriminski

Solberg

2006

J Applied Clin Med Phys

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Respiratory gated radiotherapy may allow reduction of the treatment margins, thus sparing healthy tissue and/or allowing dose escalation to the tumor. However, current commissioning and quality assurance of linear accelerators do not include evaluation of gated delivery. The purpose of this study is to test gated photon delivery of a Siemens ONCOR Avant‐Garde linear accelerator. Dosimetric characteristics for gated and nongated delivery of 6‐MV and 15‐MV photons were compared for the range of doses, dose rates, and for several gating regimes. Dose profiles were also compared using Kodak EDR2 and X‐Omat V films for 6‐MV and 15‐MV photons for several dose rates and gating regimes. Results showed that deviation is less than or equal to 0.6% for all dose levels evaluated with the exception of the lowest dose delivered at 25 MU at an unrealistically high gating frequency of 0.5 Hz. At 400 MU, dose profile deviations along the central axes in in‐plane and cross‐plane directions within 80% of the field size are below 0.7%. No unequivocally detectable dose profile deviation was observed for 50 MU. Based on the comparison with widely accepted standards for conventional delivery, our results indicate that this LINAC is well suited for gated delivery of nondynamic fields.PACS numbers: 87.56‐By, 87.66‐Cd, 87.66‐Jj

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Section: Discussionsupporting

confidence: 67%

Dosimetric characteristics of a new linear accelerator under gated operation

Kriminski

Solberg

2006

J Applied Clin Med Phys

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“…TG 100 concurs with previously published QA guidance and community consensus that quality assurance test procedures and tolerance limits for the performance of radiotherapy planning and delivery systems should be dictated by the requirement to reduce overall uncertainty (random and systematic) in delivered radiation dose to a patient to less than 5%. 140 One motivation for the work of TG 100 is that current QA guidance typically does not expend sufficient effort on preventing low probability "catastrophic" events 39,41-43 which pose very high risks to individual patients (random or sporadic events) or to groups of patients (systematic events). Sporadic catastrophic events, e.g., treatment of IMRT fields without movement of the MLC leaves, can entail interactions between users and device interfaces and often may be caused by upstream user errors that lead very wrong input data to be propagated through the planning/delivery process, rather than by erroneous functioning of one device itself.…”

Section: Discussionmentioning

confidence: 99%

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

et al. 2016

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The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for "intensity modulated radiation therapy (IMRT)" as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.

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“…This document is part of a series of medical physics practice guidelines commissioned by the American Association of Physicists in Medicine (AAPM) intended to describe acceptable standards for various aspects of clinical medical physics. The implementation of comprehensive quality assurance (QA) programs recommended in AAPM Task Group Reports is encouraged. The purpose of this guideline is to provide a list of critical performance tests in order to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective QA program that matches the clinical use of the accelerator.…”

Section: Goals and Rationalementioning

confidence: 99%

AAPM Medical Physics Practice Guideline 8.a.: Linear accelerator performance tests

Smith

Balter

Duhon³

et al. 2017

J Applied Clin Med Phys

129

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PurposeThe purpose of this guideline is to provide a list of critical performance tests in order to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator.MethodsA risk assessment was performed on tests from current task group reports on linac QA to highlight those tests that are most effective at maintaining safety and quality for the patient. Recommendations are made on the acquisition of reference or baseline data, the establishment of machine isocenter on a routine basis, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance.ResultsThe recommended tests proposed in this guideline were chosen based on the results from the risk analysis and the consensus of the guideline's committee. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test.ConclusionThis guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics.

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Physical Aspects of Quality Assurance in Radiation Therapy

Cited by 54 publications

References 0 publications

Dosimetric characteristics of a new linear accelerator under gated operation

Dosimetric characteristics of a new linear accelerator under gated operation

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

AAPM Medical Physics Practice Guideline 8.a.: Linear accelerator performance tests

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