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Results of IAEA supported TPS audit in Europe Eduard Gershkevitsh North Estonia Medical Center...
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Transcript of Results of IAEA supported TPS audit in Europe Eduard Gershkevitsh North Estonia Medical Center...
Results of IAEA supported TPS audit in
Europe
Eduard Gershkevitsh
North Estonia Medical Center
Tallinn, Estonia
• TPS audit uses IAEA TECDOC 1583 methodology
• IAEA provides CIRS Thorax phantom on loan for 6 month to the Member State
• IAEA together with national audit coordinator (Medical Physics group, RT department nominated by the national authorities) organise one day workshop in the country
• National audit coordinator’s centre is audited by independent auditor
• National audit coordinator is performing audits through on site visits
Principles of operation
IAEA TECDOC 1583 methodology
• Based on anthropomorphic phantom
• To verify that logistic chain: CT scanning
Treatment planning
Data transfer
Dose delivery
is operational and leads to desired results with sufficient accuracy
•Employs ionisation chamber measurements
IAEA TECDOC 1583 methodology
• Eight test cases with 15 measurement points Single 10x10cm2 field at nominal SSD
Tangential field with wedge
Corner blocks
4-field “box”
Customised blocking
Oblique incidence with L-shape block
Half fields with wedges
Non-coplanar field arrangement
•Agreement criteria 2-5% depending on complexity
• B. Petrovic – Institute of Oncology Vojvodina, Sremska Kamenica, Serbia
• C. Pesznyak – National Institute of Oncology, Budapest, Hungary
• K. Chelminski – M. Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
• J. Grezdo – St. Elizabeth Institute of Oncology, Bratislava, Slovakia
• M. do Carmo Lopes – Portuguese Institute of Oncology, Coimbra, Portugal
• E. Gershkevitsh – North Estonia Medical Centre, Tallinn, Estonia
National TPS audit coordinators
Participants of the TPS Audit
• 8 countries
• 61 centres
• 195 datasets (combination of algorithms and beam quality)
• CT to RED conversion curve required adjustment in 2/3 of centres (criteria used adopted from IAEA TRS 430 – for the same electron density the variation should not exceed ± 20HU for all materials except water (± 5HU)
CT to RED conversion
• Discrepancies requiring intervention and not related to algorithm limitations were found in approximately 9% of datasets
Reasons for deviations
Calibration39%
Input beam data and model fitting
50%
Mech. problems 11%
Dosimetry problems
Calibration
• Use of chamber with outdated calibration factor
• Use of plastic phantom instead of water for calibration
• Incorrect value in TPS
Input beam data & model fitting
• Typographic errors
• Use of standard data
• Quality of measurement data
• Sub-optimal beam fitting
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12
Centres
% o
f m
ea
sure
me
nt
po
ints
exc
ee
din
g
ag
ree
me
nt
crite
ria
4-6MV Varian HE
10-18MV Varian HE
Problems with model beam fitting
Problems with treatment unit
• New couch top was installed and unaccounted. This lead to 8% underdose from posterior fields
• Loose mechanical wedge
Accuracy achievable
• With corrected data and advanced algorithms the majority of the measurements are within agreement criteria
Conclusion
• Input beam data and suboptimal beam modelling were the largest contributors to observed deviations
• CT to RED conversion is customised in minority of centres
• The majority of observed deviations have been corrected
• Contribution to better understanding of TPS performance and its limitations
Acknowledgement
• Stanislav Vatnitsky for drafting a proposal for TPS audit
• Joanna Izewska for support and implementation of the TPS audit at IAEA
• To national audit coordinators
• To medical physicist at audited RT departments
Thank you for attention!
More details: Gershkevitsh E, Pesznyak C, Petrovic B, Grezdo J, Chelminski K, do Carmo Lopes M, Izewska J, Van Dyk J. Dosimetric inter-institutional comparison in European radiotherapy centres: Results of IAEA supported treatment planning system audit. Acta Oncol. 2014 May;53(5):628-36.