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Setting up a Radiotherapy Programme: Clinical Medical 244 pages 14.42 mm Setting Up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects Radiation Protection and Safety Medical Physics, Programme: Clinical, Setting Up a Radiotherapy Setting Up a Radiotherapy Programme: This publication provides guidance for designing and implementing radiotherapy programmes, taking into account clinical, medical Clinical, Medical Physics, physics, radiation protection and safety aspects. It reflects the up-to- date requirements for radiotherapy infrastructure in resource limited Radiation Protection and Safety Aspects settings. It is addressed to professionals and administrators involved in the development, implementation and management of radiotherapy programmes. INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA ISBN 92–0–101807–X P1296_covI+IV.indd 1 2008-01-30 09:45:29 SETTING UP A RADIOTHERAPY PROGRAMME: CLINICAL, MEDICAL PHYSICS, RADIATION PROTECTION AND SAFETY ASPECTS The following States are Members of the International Atomic Energy Agency: AFGHANISTAN GREECE NORWAY ALBANIA GUATEMALA PAKISTAN ALGERIA HAITI PALAU ANGOLA HOLY SEE PANAMA ARGENTINA HONDURAS PARAGUAY ARMENIA HUNGARY PERU AUSTRALIA ICELAND PHILIPPINES AUSTRIA INDIA POLAND AZERBAIJAN INDONESIA PORTUGAL BANGLADESH IRAN, ISLAMIC REPUBLIC OF QATAR BELARUS IRAQ REPUBLIC OF MOLDOVA BELGIUM IRELAND ROMANIA BELIZE ISRAEL RUSSIAN FEDERATION BENIN ITALY SAUDI ARABIA BOLIVIA JAMAICA SENEGAL BOSNIA AND HERZEGOVINA JAPAN SERBIA BOTSWANA JORDAN SEYCHELLES BRAZIL KAZAKHSTAN SIERRA LEONE BULGARIA KENYA SINGAPORE BURKINA FASO KOREA, REPUBLIC OF SLOVAKIA CAMEROON KUWAIT SLOVENIA CANADA KYRGYZSTAN SOUTH AFRICA CENTRAL AFRICAN LATVIA SPAIN REPUBLIC LEBANON SRI LANKA CHAD LIBERIA SUDAN CHILE LIBYAN ARAB JAMAHIRIYA SWEDEN CHINA LIECHTENSTEIN SWITZERLAND COLOMBIA LITHUANIA SYRIAN ARAB REPUBLIC COSTA RICA LUXEMBOURG TAJIKISTAN CÔTE D’IVOIRE MADAGASCAR THAILAND CROATIA MALAWI THE FORMER YUGOSLAV CUBA MALAYSIA REPUBLIC OF MACEDONIA CYPRUS MALI TUNISIA CZECH REPUBLIC MALTA TURKEY DEMOCRATIC REPUBLIC MARSHALL ISLANDS UGANDA OF THE CONGO MAURITANIA UKRAINE DENMARK MAURITIUS UNITED ARAB EMIRATES DOMINICAN REPUBLIC MEXICO UNITED KINGDOM OF ECUADOR MONACO GREAT BRITAIN AND EGYPT MONGOLIA NORTHERN IRELAND EL SALVADOR MONTENEGRO UNITED REPUBLIC ERITREA MOROCCO OF TANZANIA ESTONIA MOZAMBIQUE UNITED STATES OF AMERICA ETHIOPIA MYANMAR URUGUAY FINLAND NAMIBIA UZBEKISTAN FRANCE NETHERLANDS VENEZUELA GABON NEW ZEALAND VIETNAM GEORGIA NICARAGUA YEMEN GERMANY NIGER ZAMBIA GHANA NIGERIA ZIMBABWE The Agency’s Statute was approved on 23 October 1956 by the Conference on the Statute of the IAEA held at United Nations Headquarters, New York; it entered into force on 29 July 1957. The Headquarters of the Agency are situated in Vienna. Its principal objective is “to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world’’. SETTING UP A RADIOTHERAPY PROGRAMME: CLINICAL, MEDICAL PHYSICS, RADIATION PROTECTION AND SAFETY ASPECTS INTERNATIONAL ATOMIC ENERGY AGENCY VIENNA, 2008 COPYRIGHT NOTICE All IAEA scientific and technical publications are protected by the terms of the Universal Copyright Convention as adopted in 1952 (Berne) and as revised in 1972 (Paris). The copyright has since been extended by the World Intellectual Property Organization (Geneva) to include electronic and virtual intellectual property. Permission to use whole or parts of texts contained in IAEA publications in printed or electronic form must be obtained and is usually subject to royalty agreements. Proposals for non-commercial reproductions and translations are welcomed and considered on a case-by-case basis. Enquiries should be addressed to the IAEA Publishing Section at: Sales and Promotion, Publishing Section International Atomic Energy Agency Wagramer Strasse 5 P.O. Box 100 1400 Vienna, Austria fax: +43 1 2600 29302 tel.: +43 1 2600 22417 email: [email protected] http://www.iaea.org/books © IAEA, 2008 Printed by the IAEA in Austria February 2008 STI/PUB/1296 IAEA Library Cataloguing in Publication Data Setting up a radiotherapy programme : clinical, medical physics, radiation protection and safety aspects. — Vienna : International Atomic Energy Agency, 2008. p. ; 24 cm. STI/PUB/1296 ISBN 92–0–101807–X Includes bibliographical references. 1. Radiation — Safety measures. 2. Radiotherapy. 3. Cancer — Treatment. 4. Radioisotope brachytherapy. I. International Atomic Energy Agency. IAEAL 07–00493 FOREWORD The incidence of cancer is increasing, particularly because of the increase in life expectancy arising from worldwide improvements in standards of living. According to recent estimates of the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO), approximately ten million new cases of cancer are being detected per year worldwide, with slightly more than half of the cases occurring in developing countries. By the year 2015 this number is expected to increase to about 15 million cases, of which two thirds will occur in developing countries. About half of all cancer patients receive radiotherapy, either as part of their primary treatment or in connection with recurrences or palliative treatment. Radiotherapy is a multidisciplinary specialty which uses complex equipment and radiation sources for the delivery of treatment. It is estimated that approximately 3300 teletherapy machines are currently installed in developing countries. This figure is significantly below the estimated needs, of almost 5000 machines at present and about 10 000 machines by the year 2015. Taking this into account, in addition to the great need for qualified professionals (radiation oncologists, medical radiotherapy physicists, radiotherapy technicians, radiation protection officers, maintenance engineers, etc.), the future development of the medical infrastructure for cancer treatment appears to be a substantial undertaking. While the present publication discusses radiation treatment programmes alone, it is recognized that other components of comprehensive cancer management programmes, such as cancer prevention and diagnosis, also need to be addressed. It is widely acknowledged that the clinical aspects (diagnosis, treatment decision making, indication for treatment and follow-up), as well as the procedures related to the physical and technical aspects of patient treatment, must be subjected to careful control and planning in order to ensure safe, high quality, radiotherapy. While it has long been recognized that the physical aspects of quality assurance in radiotherapy are vital to achieving effective and safe treatment, it has been increasingly acknowledged that a systematic approach is necessary for all the steps within the clinical and technical aspects of radiotherapy programmes as well. The need to establish general guidelines at the IAEA, taking into account the clinical, medical physics, radiation protection and safety considerations for designing and implementing radiotherapy programmes in Member States, has been identified through the increased interest of Member States in the efficient and safe application of radiation in health care. To satisfy this need, the IAEA has convened several consultant and advisory group meetings to prepare a publication providing a basis for establishing a programme in radiotherapy. The external expertise has been substantially complemented by the contributions of a large number of IAEA staff members. The present publication supersedes IAEA-TECDOC-1040 (Design and Implementation of a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects) published in 1998. It is addressed to professionals and administrators involved in the development, implementation and management of a radiotherapy programme, in order to establish a common and consistent framework in which all the steps and procedures in radiotherapy are taken into account. The present publication has been expanded to include orthovoltage X rays and linear accelerators. Major contributors to the present publication have been P. Mayles and V. Levin, whose efforts are gratefully acknowledged. The IAEA officer responsible for this publication was J. Iżewska of the Division of Human Health. EDITORIAL NOTE Although great care has been taken to maintain the accuracy of information contained in this publication, neither the IAEA nor its Member States assume any responsibility for consequences which may arise from its use. The use of particular designations of countries or territories does not imply any judgement by the publisher, the IAEA, as to the legal status of such countries or territories, of their authorities and institutions or of the delimitation of their boundaries. The mention of names of specific companies or products (whether or not indicated as registered) does not imply any intention to infringe proprietary rights, nor should it be construed as an endorsement or recommendation on the part of the IAEA. CONTENTS 1. INTRODUCTION . 1 1.1. Global cancer burden and the need for radiotherapy . 1 2. PROGRAMME DESIGN AND IMPLEMENTATION FLOW . 6 2.1. Programme design . 6 2.1.1. Assessment of national needs and contrywide distribution of radiotherapy facilities . 6 2.1.2. Assessment of institution’s clinical needs . 7 2.1.3. Basic clinical essentials . 7 2.1.4. Assessment of institution’s infrastructure and resources . 8 2.1.5. Formulation of radiotherapy programmes . 11 2.2. Programme implementation . 13 2.2.1. Staff training . 13 2.2.2. Equipment specification . 13 2.2.3.
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