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Vijande J, Carmona V, Lliso F, Ballester F, Perez-Calatayud J. An efficient component of the redundancy calibration program to ensure equipment stability by assaying HDR Ir-192 sources at the time of replacement. J Appl Clin Med Phys 2024:e14509. [PMID: 39238193 DOI: 10.1002/acm2.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/01/2024] [Accepted: 07/24/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Brachytherapy (BT) treatments involving temporary high-dose rate (HDR) sources are extensively employed in clinical practice. Ensuring the consistency of all measurement equipment at the hospital level is crucial, requiring a robust redundancy and consistency program. This enables the institution to verify the stability of the dosimetry system over time. PURPOSE To describe, justify, and analyze a component of the redundancy program of the calibration protocols followed by the Radiotherapy Department of the Hospital Universitari i Politècnic La Fe (València, Spain) during the last 10 years for the case of HDR BT as an additional component to ensure long term stability of the measurement equipment. METHODS At the time the HDR BT source is replaced, its Air Kerma Strength (SK) is measured. By comparing this value with the one obtained at the time of installation (corrected by decay), a clear determination of the stability of the measurement equipment can be performed. RESULTS Difference between SK,vendor and SK,hosp as a function of the measurement date is reported for a 10 years' period. All measurements are well within the ±3% tolerance level recommended in current international guidelines. Percentage differences of SK,hosp values at the time of replacement compared to SK,hosp ones at the time when the source was installed are within the ±0.5% range, reflecting oscillations around a null deviation. CONCLUSIONS The method proposed allows any hospital to ensure a redundancy component of the long-term stability of all equipment involved in BT measurements in a very simple and time efficient manner. Additionally, it enables the hospital to maintain a detailed log of historical differences, facilitating the identification and correction of potential systematic deviations over time.
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Affiliation(s)
- Javier Vijande
- Departamento de Física Atómica, Molecular y Nuclear, Universitat de Valencia (UV), Burjassot, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), València, Spain
- Instituto de Física Corpuscular, IFIC (UV-CSIC), Burjassot, Spain
| | - Vicente Carmona
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), València, Spain
- Radiotherapy Department, Hospital Universitari i Politècnic La Fe de València, València, Spain
| | - Françoise Lliso
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), València, Spain
- Radiotherapy Department, Hospital Universitari i Politècnic La Fe de València, València, Spain
| | - Facundo Ballester
- Departamento de Física Atómica, Molecular y Nuclear, Universitat de Valencia (UV), Burjassot, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), València, Spain
| | - Jose Perez-Calatayud
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), València, Spain
- Radiotherapy Department, Hospital Universitari i Politècnic La Fe de València, València, Spain
- Radiotherapy Department. Hospital Clínica Benidorm, Alicante, Spain
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De Brabandere M, Placidi E, Siebert FA, Carlsson Tedgren Å, Slocker Escarpa A, Tagliaferri L, Andrássy M, Schulz C, Fog LS. GEC-ESTRO survey of 106Ru eye applicator practice for ocular melanoma - Physicist survey. Radiother Oncol 2024; 193:110114. [PMID: 38309583 DOI: 10.1016/j.radonc.2024.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
AIM 106Ru eye plaque brachytherapy (BT, interventional radiotherapy) is an eye-preserving treatment for uveal melanoma performed in about 100 clinics worldwide. Despite this relatively low number, there is a considerable variation in clinical practice. In 2022, the BRAPHYQS and Head & Neck and Skin GEC-ESTRO working groups conducted a survey to map the current clinical practice. The survey consisted of a physicist and a physician part. This paper describes the physicist results. However, three physician questions with overlapping interest are included here as well. MATERIALS AND METHODS The survey questions pertained to commissioning and quality control (QC) of the plaques, treatment planning, radiobiological correction, as well as more general questions on practice improvement. The questions overlapping with the physician survey were related to dose prescription and margins. RESULTS Sixty-five physicist responses were included. A majority of the centres do not perform an independent measurement of the absorbed dose at reference depth, percentage depth dose (PDD) and off-axis data. A lack of calibration services and suitable equipment are the main reasons. About one third of the centres indicated that they do image based treatment planning. The use of margins and dose prescription showed a large variability, despite the availability of guidelines [1]. Many respondents expressed a strong wish for improvement in a wide range of aspects of clinical practice. CONCLUSION The physics survey showed a wide variability regarding quality control of the 106Ru sources and treatment planning practice.
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Affiliation(s)
| | - Elisa Placidi
- UOC Physics for Life Sciences, Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Rome, Italy
| | - Michael Andrássy
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Carmen Schulz
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Lotte S Fog
- Ocular oncology unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Alfred Health Radiation Oncology, Melbourne, VIC, Australia
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Zivanovic M, Petrovic B, Radovanlija N, Krzanovic N, Jonic M, Marjanovic M, Komatina I. Intercomparison and constancy check of brachytherapy well-type chambers as a means to improve the quality of measurements in Serbia. Appl Radiat Isot 2024; 205:111160. [PMID: 38171076 DOI: 10.1016/j.apradiso.2023.111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
Source strength measurements are of critical importance for brachytherapy and are often performed in hospitals using well-type chambers. Quality assurance and quality control procedures should be implemented, but that may prove difficult in some hospitals due to the lack of equipment or metrological support. A study was conducted to investigate the status of the measurement equipment in Serbian hospitals and to organize an intercomparison campaign using a hospital 192Ir source. All the hospitals were able to measure the source strength with the required accuracy, but the quality assurance can be improved. Two hospitals performed stability checks, which were evaluated. Uncertainty budget was created during the exercise and is presented in this paper. The described methodology can be used to quickly assess the performance of brachytherapy centers, and can be easily adapted to calibration procedure.
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Affiliation(s)
- Milos Zivanovic
- Vinca Institute of Nuclear Sciences - National Institute of thе Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11351 Vinča, Belgrade, Serbia.
| | - Borislava Petrovic
- Faculty of Sciences, Department of Physics, University Novi Sad, trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia; Oncology Institute of Vojvodina, Radiotherapy Clinic, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Nevena Radovanlija
- Faculty of Sciences, Department of Physics, University Novi Sad, trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
| | - Nikola Krzanovic
- Vinca Institute of Nuclear Sciences - National Institute of thе Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11351 Vinča, Belgrade, Serbia
| | - Milos Jonic
- Radiotherapy Department, Clinic for Oncology, University Clinical Center Nis, Bulevar Dr Zorana Djindjica 48, 18000 Nis, Serbia
| | - Milana Marjanovic
- Faculty of Sciences, Department of Physics, University Novi Sad, trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia; Oncology Institute of Vojvodina, Radiotherapy Clinic, Put Doktora Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Ivana Komatina
- Vinca Institute of Nuclear Sciences - National Institute of thе Republic of Serbia, University of Belgrade, Mike Petrovica Alasa 12-14, 11351 Vinča, Belgrade, Serbia; Faculty of Physical Chemistry, University of Belgrade, Studentski trg 12-16, 11158 Belgrade, Serbia
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McDonald F, Belka C, Hurkmans C, Alicja Jereczek-Fossa B, Poortmans P, van de Kamer JB, Azizaj E, Franco P. Introducing the ESTRO Guidelines Committee, driving force for the new generation of ESTRO guidelines. Radiother Oncol 2023:109724. [PMID: 37244357 DOI: 10.1016/j.radonc.2023.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Fiona McDonald
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; Division of Radiotherapy & Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich; German Cancer Consortium (DKTK), partner site Munich; Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Eralda Azizaj
- European Society for Radiotherapy and Oncology, Brussels, Belgium
| | - Pierfrancesco Franco
- Department of Translational Medicine (DIMET), University of Eastern Piedmont, Novara, Italy; Department of Radiation Oncology, 'Maggiore della Carità' University Hospital, Novara, Italy.
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Poder J, Rivard MJ, Howie A, Carlsson Tedgren Å, Haworth A. Risk and Quality in Brachytherapy From a Technical Perspective. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00002-X. [PMID: 36682968 DOI: 10.1016/j.clon.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
AIMS To provide an overview of the history of incidents in brachytherapy and to describe the pillars in place to ensure that medical physicists deliver high-quality brachytherapy. MATERIALS AND METHODS A review of the literature was carried out to identify reported incidents in brachytherapy, together with an evaluation of the structures and processes in place to ensure that medical physicists deliver high-quality brachytherapy. In particular, the role of education and training, the use of process and technical quality assurance and the role of international guidelines are discussed. RESULTS There are many human factors in brachytherapy procedures that introduce additional risks into the process. Most of the reported incidents in the literature are related to human factors. Brachytherapy-related education and training initiatives are in place at the societal and departmental level for medical physicists. Additionally, medical physicists have developed process and technical quality assurance procedures, together with international guidelines and protocols. Education and training initiatives, together with quality assurance procedures and international guidelines may reduce the risk of human factors in brachytherapy. CONCLUSION Through application of the three pillars (education and training; process control and technical quality assurance; international guidelines), medical physicists will continue to minimise risk and deliver high-quality brachytherapy treatments.
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Affiliation(s)
- J Poder
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Physics, University of Sydney, Camperdown, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
| | - M J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, RI, USA
| | - A Howie
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Å Carlsson Tedgren
- Department of Health, Medicine and Caring Sciences (HMV), Radiation Physics, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, The Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, The Karolinska Institute, Stockholm, Sweden
| | - A Haworth
- School of Physics, University of Sydney, Camperdown, New South Wales, Australia
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