Radiation Oncology Quality and Safety Considerations in Low Resource Settings: A Medical Physics Perspective

The last few years have seen a significant growth of interest in the global radiation therapy crisis. Various organizations have quantified the need and are providing aid in support of addressing the shortfalls existing in many low-to-middle income countries (LMICs). With the tremendous demand for new facilities, equipment and personnel, it is very important to recognize the quality and safety challenges and to address them directly. An examination of publications on quality and safety in radiation therapy indicates a consistency in a number of the recommendations; however, these authoritative reports were generally based on input from high-resourced contexts. Here we review these recommendations with a special emphasis on issues that are significant in LMICs. While multidimensional, training and staffing are top priorities; any support provided to lower resourced settings must address the numerous facets associated with quality and safety indicators. Strong partnerships between high-income and other countries will enhance the development of safe and resource-appropriate strategies for advancing the radiation treatment process. The real challenge is the engagement of a strong spirit of cooperation, collaboration and communication between the multiple organizations in support of reducing the cancer divide and improving the provision of safe and effective radiation therapy

Accuracy requirements and uncertainties in radiotherapy: a report of the International Atomic Energy Agency.

BACKGROUND: Radiotherapy technology continues to advance and the expectation of improved outcomes requires greater accuracy in various radiotherapy steps. Different factors affect the overall accuracy of dose delivery. Institutional comprehensive quality assurance (QA) programs should ensure that uncertainties are maintained at acceptable levels. The International Atomic Energy Agency has recently developed a report summarizing the accuracy achievable and the suggested action levels, for each step in the radiotherapy process. Overview of the report: The report seeks to promote awareness and encourage quantification of uncertainties in order to promote safer and more effective patient treatments. The radiotherapy process and the radiobiological and clinical frameworks that define the need for accuracy are depicted. Factors that influence uncertainty are described for a range of techniques, technologies and systems. Methodologies for determining and combining uncertainties are presented, and strategies for reducing uncertainties through QA programs are suggested. The role of quality audits in providing international benchmarking of achievable accuracy and realistic action levels is also discussed. RECOMMENDATIONS: The report concludes with nine general recommendations: (1) Radiotherapy should be applied as accurately as reasonably achievable, technical and biological factors being taken into account. (2) For consistency in prescribing, reporting and recording, recommendations of the International Commission on Radiation Units and Measurements should be implemented. (3) Each institution should determine uncertainties for their treatment procedures. Sample data are tabulated for typical clinical scenarios with estimates of the levels of accuracy that are practically achievable and suggested action levels. (4) Independent dosimetry audits should be performed regularly. (5) Comprehensive quality assurance programs should be in place. (6) Professional staff should be appropriately educated and adequate staffing levels should be maintained. (7) For reporting purposes, uncertainties should be presented. (8) Manufacturers should provide training on all equipment. (9) Research should aid in improving the accuracy of radiotherapy. Some example research projects are suggested

International Conference on Advances in Radiation Oncology (ICARO): Outcomes of an IAEA Meeting

The IAEA held the International Conference on Advances in Radiation Oncology (ICARO) in Vienna on 27-29 April 2009. The Conference dealt with the issues and requirements posed by the transition from conventional radiotherapy to advanced modern technologies, including staffing, training, treatment planning and delivery, quality assurance (QA) and the optimal use of available resources. The current role of advanced technologies (defined as 3-dimensional and/or image guided treatment with photons or particles) in current clinical practice and future scenarios were discussed

Medical Physics Beyond Borders: IAEA Educational Resources Relevant to Both the Developed and Developing World : WE-G-BRC-03

Purpose: To summarize the medical physicseducational and training materials freely available through the website of the International Atomic Energy Agency (IAEA). Methods: The IAEA works for the safe, secure and peaceful uses of nuclear science and technology. Much this work relates to human health, including the worldwide cancer problem. The medical physicist fulfils an essential role in the safe and effective use of radiation in medicine, most commonly in cancertreatment, x‐ray diagnosticimaging and nuclear medicine. The IAEA produces a large amount of educational and training materials much of which is relevant to the medical physics community worldwide. Resource materials range from setting up a radiation therapy program, to dosimetry calibration protocols, quality assurance guidance documents, basic medical physicseducation textbooks, along with thousands of ready‐made PowerPoint slides downloadable and ready to use by students and instructors. Furthermore, a detailed residency training program is now available for radiation oncology physics and similar material for diagnostic radiology and nuclear medicine physicists is in print. Results: These resource materials are available through the IAEA website, http://www.iaea.org and subcomponents of this website including the newly developed website called “IAEA Human Health Campus”, http://humanhealth.iaea.org. Furthermore, there are significant patient safety resources available through the “Radiation Protection of the Patient” website, http://rpop.iaea.org/, also including multiple PowerPoint presentations. New teaching/learning resources are being developed for advancing to more sophisticated image‐basedradiation therapy, ranging from 2‐D to intensity‐modulated and image‐guidedradiation therapy. Conclusions: The IAEA has developed a wealth of educational resources now readily and freely available through its new “Human Health Campus” website. These resource materials and website contents are continuously evolving to meet the increasing needs of the IAEA member states. The emphasis is on advancing radiation medicine safely and effectively. Many of these resources are useful to the medical physics community worldwide

Global radiotherapy : current status and future directions : white paper

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide. (C) 2021 by American Society of Clinical Oncolog

Detector to detector corrections: a comprehensive experimental study of detector specific correction factors for beam output measurements for small radiotherapy beams

Purpose: The aim of the present study is to provide a comprehensive set of detector specific correction factors for beam output measurements for small beams, for a wide range of real time and passive detectors. The detector specific correction factors determined in this study may be potentially useful as a reference data set for small beam dosimetry measurements.Methods: Dose response of passive and real time detectors was investigated for small field sizes shaped with a micromultileaf collimator ranging from 0.6 × 0.6 cm2 to 4.2 × 4.2 cm2 and the measurements were extended to larger fields of up to 10 × 10 cm2. Measurements were performed at 5 cm depth, in a 6 MV photon beam. Detectors used included alanine, thermoluminescent dosimeters (TLDs), stereotactic diode, electron diode, photon diode, radiophotoluminescent dosimeters (RPLDs), radioluminescence detector based on carbon-doped aluminium oxide (Al2O3:C), organic plastic scintillators, diamond detectors, liquid filled ion chamber, and a range of small volume air filled ionization chambers (volumes ranging from 0.002 cm3 to 0.3 cm3). All detector measurements were corrected for volume averaging effect and compared with dose ratios determined from alanine to derive a detector correction factors that account for beam perturbation related to nonwater equivalence of the detector materials.Results: For the detectors used in this study, volume averaging corrections ranged from unity for the smallest detectors such as the diodes, 1.148 for the 0.14 cm3 air filled ionization chamber and were as high as 1.924 for the 0.3 cm3 ionization chamber. After applying volume averaging corrections, the detector readings were consistent among themselves and with alanine measurements for several small detectors but they differed for larger detectors, in particular for some small ionization chambers with volumes larger than 0.1 cm3