Transcript Izewska Joanna IAEA quality audits in radiotherapy

IAEA quality audits in radiotherapy
Joanna Izewska
Head, Dosimetry Laboratory
Dosimetry & Medical Radiation Physics Section, Division of Human Health
IAEA
International Atomic Energy Agency
IAEA audits in radiotherapy
• SINCE 1969: IAEA/WHO TLD postal dose audits of
radiotherapy beam calibration (45 years of operation):
130 countries, >2000 hospitals, >10000 beam checks
• SINCE 2005:
Quality Assurance
Team for Radiation
Oncology (QUATRO)
• SINCE 2010:
TPS end-to-end audits
IAEA
1969-2013: N = 10226 , m = 1.008, SD = 0.08, 83% res. within 5% limit
±5%
2012-2013: N = 1271 , m = 1.005, SD = 0.068, 92% res. within 5%
Currently >90% results are within 5% acceptance limit
IAEA
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TLD results within the 5% limit
Fraction of results within 5% limit
1.0
0.9
0.8
0.7
0.6
after follow-up
1st check
0.5
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Year
IAEA
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TLD results: use of CoPs (2000-2013)
TLD results 2000-2013
100
90
Percentage using protocol
80
ND,w based
Nk based
Nx based
CoP
N
Mean
DTLD/Dstat
SD (%)
ND,w
3557
1.005
2.7
Nk
1293
1.006
3.3
Nx
364
1.018
4.8
Unknown
1284
1.011
5.2
70
60
50
40
126 deviations beyond 20% excluded
30
Nx based
7%
20
Nk based
25%
10
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year of irradiation
IAEA
ND,w based
68%
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IAEA TPS audit procedures
Set of practical tests for dosimetry
calculations reflecting basic treatment
techniques in a typical radiotherapy
hospital
IAEA
IAEA scientific secretary: S. Vatnitsky
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IAEA supported TPS audit in Europe
• Eight European countries
conducted TPS audits with the
IAEA support
• Approx. 60 hospitals
participated
• Approx. 200 datasets have
been collected for beam/TPS
algorithm combination
• Several dosimetry and TPSrelated problems were identified
and fixed
IAEA
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Comprehensive RT audit: QUATRO
IAEA
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QUATRO audit procedures
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•
•
•
Auditors: RO, MP, RTT
Typically 5 days per RT centre
Entrance briefing
Assessment: tour of facility, staff
interviews, review & evaluation of
procedures and documentation,
measurements, tests, observation of
practical work
• Exit briefing: feedback to the
department, preliminary
recommendations, questions,
discussion.
IAEA
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QUATRO missions
lower middle income
upper middle income
high income
• Training of auditors and regional QUATRO workshops in all regions
• 70 QUATRO missions to date: Africa – 6; Asia – 18; Europe – 30 + 3 reaudits; Latin America – 13
IAEA
Europe: recommendations by QUATRO
• Support staff continuous
•
•
•
•
•
•
IAEA
development
Strengthen QA programmes
and procedures
Equipment: get more, use
better
Increase staffing levels: MP,
RO, RTT
Staff requires training: RTT,
RO, MP
Improve treatment protocols
Improve structure and
organization of cancer centres
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THANK YOU
IAEA
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