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A Practical Guide to Quality Control of Brachytherapy Equipment

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A Practical Guide to Quality Control of Brachytherapy Equipment A PRACTICAL QUALITY GUIDE TO CONTROL OF BRACHYTHERAPY EQUIPMENT In January 2001 the European Society for Therapeutic Radiology and Oncology (ESTRO) submitted a large-scale project to the European Commission for funding, to boost ESTRO’s efforts for improved quality in radiotherapy. The project was named ESQUIRE, Education, Science and QUality Assurance Edited by In Radiotherapy in Europe. Financial support was obtained for a time period of two years, giving the Jack Venselaar Society’s sustained efforts for setting benchmarks for quality in the clinical practice of radiotherapy in José Pérez-Calatayud Europe an important boost. The 6 different ESQUIRE projects reflect the priorities defined by the var- ious ESTRO committees and working parties. Task 6, BRAPHYQS, concerned the investigation of methods for improving quality assurance in brachytherapy. BRAPHYQS, the development of a Supported by the EU BRAchytherapy PHYsics Quality Assurance System, was set-up (i) to analyse the existing quality “Europe against Cancer” Programme assurance (QA) procedures in different countries and to propose a set of European guidelines, and (ii) Grant Agreements N°SPC.2002480 / S12.322029 to develop methods for a mailed quality control system for checking both the dosimetric and the geo- metric reconstruction accuracy in brachytherapy departments. The present booklet is the result of part A PRACTICAL GUIDE TO QUALITY CONTROL (i) of this task. OF BRACHYTHERAPY EQUIPMENT It was decided to present a comprehensive booklet in which a broad range of physics aspects and qual- ity control applications of brachytherapy are discussed. The booklet includes the methodology of QC steps with the recommended frequencies and tolerances, and it is practical in its use for the medical physicists in countries of the European Community and abroad. The contents reflect the present-day opinions on QC, expressed in the existing publications. This booklet is not meant to replace existing national protocols for QA of brachytherapy equipment and procedures, but can be used in addition to that material and it may form a sound basis for development of such recommendations in those coun- tries where protocols do not (yet) exist. The chapter on source calibration is closely following the recent IAEA TecDoc-1274, with simplified access to numerical data. One chapter is devoted to dose calcula- tion and brachytherapy treatment planning systems (TPS). An overview is presented of the general TPS structure, source modelling, the AAPM TG-43 formalism, international recommendations and practical considerations. It provides guidelines, using referenced data, and brachytherapy source information rel- evant to the current dosimetry formalism and treatment planning systems. Finally the reader will find updated (referenced) source data to be used as input to TPSs and to fully verify and benchmark TPS EUROPEAN SOCIETYTHERAPEUTIC RADIOLOGY FOR AND ONCOLOGY dose calculations. These data are presented as tables of absorbed dose in water. In addition, recommend- ed values for the quantities used in the TG-43 formalism for a comprehensive list of brachytherapy sources used in clinical practice are provided. Reference is made to the main websites in order to find the most updated version of these data sets. J.L.M. Venselaar – Dr. B. Verbeeten Instituut – Tilburg J. Pérez-Calatayud – Servicio de Radioterapia, Hospital La Fe – Valencia ISBN 90-804532-8 © 2004 by ESTRO EUROPEAN GUIDELINES FOR QUALITY ASSURANCE IN RADIOTHERAPY BOOKLET NO. 8 Supported by the EU “Europe against Cancer” Programme Grant Agreements N°SPC.2002480 S12.322029 A PRACTICAL GUIDE TO QUALITY CONTROL OF BRACHYTHERAPY EQUIPMENT Margaret Bidmead Edith Briot Janez Burger Ivaldo Ferreira Erik Grusell Christian Kirisits Peter Kneschaurek Maryla Malgorzata Kawczynska Cristina Marchetti Taran Paulsen Hellebust José Pérez-Calatayud Alex Rijnders Amélie Roué Nuno Teixeira Heikki Tölli Jack Venselaar EUROPEAN GUIDELINES FOR QUALITY ASSURANCE IN RADIOTHERAPY ESTRO Booklet No. 8 Edited by: Jack Venselaar and José Pérez-Calatayud A PRACTICAL GUIDE TO QUALITY CONTROL OF BRACHYTHERAPY EQUIPMENT (Edited by: Venselaar, Pérez-Calatayud) 2004 – First edition ISBN 90-804532-8 ©2004 by ESTRO All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owners. ESTRO Mounierlaan 83/12 – 1200 Brussels (Belgium) CONTENTS: ESTRO BOOKLET NO. 8: A PRACTICAL GUIDE TO QUALITY CONTROL OF BRACHYTHERAPY EQUIPMENT AUTHORS i CONTENTS iii LIST OF SYMBOLS AND ABBREVIATIONS vi 1 INTRODUCTION 1 1.1 Objectives of this booklet 1 1.2 Principles of Quality Management 3 1.3 Recent literature relevant to QA in brachytherapy 5 1.4 Limitations of this booklet 10 1.5 Tolerances and frequencies in this booklet 10 2 AFTERLOADING EQUIPMENT 13 2.1 Afterloading 13 2.2 Manual afterloading 13 2.3 Remotely controlled afterloading equipment 15 2.3.1 Remotely controlled LDR and MDR afterloading systems 16 2.3.2 Remotely controlled HDR and PDR equipment 19 2.4 Endovascular brachytherapy 24 2.5 Imaging assisted brachytherapy 25 3 CALIBRATION OF BRACHYTHERAPY SOURCES 31 3.1 Introduction 31 3.2 Specification of brachytherapy gamma ray sources 31 3.3 In-air measurement technique 33 3.3.1 Formalism for reference air kerma rate 33 3.3.2 Ionisation chambers to be used 34 3.3.3 Air kerma calibration of ionisation chambers 34 3.3.4 Correction factors for in-air measurements 35 3.4 Calibration using well type chambers 45 3.5 Calibration using solid phantoms 49 3.6 Relative measurements 50 4 RADIATION SAFETY 51 4.1 Introduction 51 4.2 Techniques and materials 51 iii 4.3 Exposure of individuals 53 4.4 Contamination by radioactive materials 56 4.5 Facility design 60 4.6 Source handling 62 4.7 Nursing care 65 4.8 Special treatments 68 5 QUALITY CONTROL PROCEDURES OF AFTERLOADING EQUIPMENT AND IMPLANTS 73 5.1 Introduction 73 5.2 HDR and PDR afterloading equipment 73 5.2.1 Safety systems 73 5.2.2 Physical parameters 75 5.2.3 Frequencies and tolerances 79 5.3 LDR and MDR afterloading equipment 79 5.3.1 Safety systems 79 5.3.2 Physical parameters 80 5.3.3 Frequencies and tolerances 81 5.4 LDR, manual afterloading 81 5.4.1 Safety and radiation protection 82 5.4.2 Physical parameters 83 5.4.3 Frequencies and tolerances 84 5.5 Recommendations for quality control with permanent implants 84 5.5.1 Safety and radiation protection 85 5.5.2 Physical parameters 86 5.5.3 Frequencies and tolerances 87 6 APPLICATORS AND APPLIANCES 89 6.1 Which applicators may be used (CE-certification) 89 6.2 Acceptance tests 89 6.3 Regular tests of applicators and transfer tubes 92 6.4 Contamination, cleaning and sterilisation 93 7 QUALITY CONTROL IN CLINICAL CASES 97 7.1 Treatment team organisation 97 7.2 Training of personnel 99 7.3 Emergency procedures 100 7.4 Procedure specific quality assurance 102 APPENDIX to chapter 7: Working instructions (examples) 109 7.A Brachytherapy of the vagina using an endovaginal stump applicator 109 7.B Iridium wire treatment 117 iv 8 TREATMENT PLANNING SYSTEMS IN BRACHYTHERAPY, TG-43 SOURCE DATA 125 8.1 Introduction 125 8.1.1 Background 125 8.1.2 Specification of source strength in treatment planning systems 126 8.1.3 Structure of treatment planning systems 127 8.1.4 Source modelling 129 8.1.5 Practical considerations 131 8.1.6 Limitations of treatment planning systems 132 8.2 TG-43 formalism 136 8.2.1 Short summary of the TG-43 formalism 136 8.2.2 Practical considerations 138 8.3 Reference source data 140 8.3.1 Criteria 140 8.3.2 Caesium-137 LDR 141 8.3.3 Iridium-192 LDR 151 8.3.4 Iridium-192 HDR 154 8.3.5 Iridium-192 PDR 159 8.3.6. Cobalt-60 HDR 162 8.3.7 Iodine-125 and Palladium-103 sources 163 APPENDIX to chapter 8: Dose calculations; figures and tables 167 8.A Classical dose calculation at a distance from a cylindrical source 167 8.B Source data sets 169 9 QUALITY ASSURANCE OF BRACHYTHERAPY TREATMENT PLANNING SYSTEMS 215 9.1 Introduction 215 9.2 The physicists tasks at commissioning and continued use of a brachytherapy TPS 216 9.3 Verification of the treatment plan 225 9.4 Clinical aspects of quality assurance of treatment planning systems 230 10 EXTERNAL AUDITS IN BRACHYTHERAPY 233 10.1 Introduction 233 10.2 Dosimetry audits 234 10.3 Check of the reconstruction algorithm 238 Acknowledgements 241 References 243 v LIST OF SYMBOLS AND ABBREVIATIONS Symbols used in this booklet A Activity Aapp Apparent activity Apn The inverse of the non-uniformity correction factor α Ratio of Rc and measurement distance r c Offset in the set-up distance Γδ Air kerma rate constant D Dose d Distance e source radius (es) or filter thickness (ef) F Anisotropy function fi Correction factor for effect i (i is explained in the respective chapters) ϕ Scatter and attenuation function of photons in the medium Φ an Anisotropy factor G Geometry factor g Radial dose function ki Correction factor for effect i for the conversion of a reading to air kerma (i is explained in the respective chapters) Kair Kerma in air Km Kerma in material m Reference air kerma rate L Length (of linear source) Lc Half-length of ionisation chamber Λ Dose rate constant Mu Measured charge with electrometer µ attenuation and absorption coefficient The ratio of average mass attenuation coefficients in material m and air, respectively Nk Air kerma calibration factor q Ratio of charge measured in a solid phantom and during calibration θ Angle R Reading of electrometer
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