Protocol Compliance Questionnaire

Protocol compliance questionnaire

Clinical information

How is gynaecological examination performed?

 Under anaesthesia?

 By a radiation oncologist?

 By a gynaecologist?

 By both?

Is gynaecological examination documented with clinical drawings?

 At diagnosis?

 At brachytherapy?

 Both?

 Are tumour dimensions indicated? MR imaging

Specify the MR image acquisition protocol

Diagnosis

Fill in the grey boxes Sequence T1 T2 T2 fat suppressed

Contrast vagina bladder intravenous

Orientation axial sagittal coronal paraxial parasagittal paracoronal

Spasmolytic Drugs yes no

Gap yes no

Borders of Field of View upper lower anterior posterior

Slice Thickness mm

Magnetic field size T Brachytherapie

Fill in the grey boxes Sequence T1 T2 T2 fat suppressed

Contrast Techniques used vagina bladder intravenous

Orientation axial sagittal coronal paraxial parasagittal paracoronal

Gap yes no

Spasmolytic Drugs yes no

Borders of Field of View upper lower anterior posterior

Slice Thickness mm

Magnetic field size T Brachytherapy

Brachytherapy procedure: US guidance? How is the applicator fixated?

Specify model and version number for: Afterloader and source strength? TPS MR scanner

Which MRI sequence is used for contouring?

Is the whole organ or wall contoured?

Which target volume is used for dose prescription?

Which target volumes are routinely contoured?

How do you define the rectosigmoid junction?

What is the contouring protocol to ensure that every part of the structure influencing the DVH calculation for D2cc is contoured?

Which imaging modality is used to reconstruct the applicator?

Is the applicator reconstructed individually or based on a library plan?

Is the library plan or the individual reconstruction based on a commissioning procedure taking into account results of autoradiography (especially how is the first dwell position defined and verified)?

How is the reconstructed geometry registered to the images used for contouring (MRI T2)? not necessary by marking points by shared DICOM coordinates by manual registration by mutual registration others

How is the accuracy of the entire reconstruction process verified in each individual patient?

How are possible active dwell positions defined to start the dose planning?

Is there a standard loading pattern? Provide dwell positions and relative or absolute dwell times.

How is optimization performed? (manual dwell times, manual dwell weights + dose points, graphical optimization/dose shaping, combinations) How is point A defined? Related to applicator geometry in a library plan?

How are the ICRU bladder and rectal points defined? (on radiographs, CT or MRI)

How was the accuracy of the dose calculation checked? TG43 parameters verified using BRAPHYQS consensus data (on website)? ESTRO EQUAL test including dose delivery performed? Other?

How are cumulative dose volume histogram parameters evaluated? PLATO: Is Brachytherapy or EVAL module used for DVH calculation? How many sampling points are used? What is the size of the box margin for evaluations of the whole dose matrix, implant DVH Brachyvision: What is the size of the dose matrix? What is the voxel size used? Flexiplan: How many sampling points are used? What is the size of the dose matrix? What is the voxel size used?

Which DVH constraints are used?

Is there a limit for high dose volumes? certain DVH parameter certain limits for dose points certain loading pattern limitations

Do you routinely use in vivo dosimetry?

Is re-optimisation sometimes performed during the BT fraction (in case of PDR)?

In case you use PDR: do you in some cases start giving pulses on a standard plan and then apply the optimised plan later? If yes: What is the maximum number of standard pulses you would apply, and how many pulses in total? Description of applicators

Please describe all kinds of applicators you are using by filling out relevant cells in the table below. Cells shaded in grey are not to be filled out.

If using customised applicators: please describe the construction in text and include a drawing/photo if necessary

If vaginal cylinder is used: 1. Single central or multichannel (Miami) cylinder? 2. Overall length of cylinder?

Distance between source channels and outer Company Model material Outer dimension (mm) applicator surface (mm) Width Length First dwell Thickness To cranial To lateral (lateral) / (cranio- position to (AP) surface surface Diameter caudal) tip Ring

Cylinder

Tandem

Needle

Customised External beam radiotherapy

Specify model and version number for LINAC TPS

Which kind of imaging is used for treatment planning? CT and MRI/PET? technique (spiral, ..), slice thickness, etc.

Which fixation technique is used? immobilization devices

What is the organ filling at time of imaging for planning and during EBRT?

Which organs at risk are delineated for EBRT treatment planning?

Which target volumes are delineated?

Which 3D margins are used for dose planning (CTV to PTV, etc..)?

What is the overall treatment time?

Which algorithm is used for dose planning pencil beam, collapsed cone, etc.

How is the accuracy of the TPS dose calculation checked (commissioning of the TPS)? IAEA or ESTRO EQUAL mailed dosimetry check? Other?

Which kind of EBRT technique is used? 3D conformal, IMRT, etc

Which field arrangement is used? 4-field box? Number of fields? Parametrial boost?

Which beam energy is used?

Use of beam modifying devices, MLC or blocks?

Which isodose lines are clinically evaluated?

What are the dose constraints for PTV, OAR, max dose? DVH constraints (absolute, relative, …) Any constraints used to ensure dose homogeneity?

Is there an independent monitor unit verification for each patient, which algorithm is used?

How is the geometrical set-up of the patient checked (port films, EPID, CBCT) AP, lateral How often? Use of metallic markers in the cervix?