InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

The external audit of therapy beams : Equal-Estro Experience

EqualEstro,adosimetrylaboratorykeepingpacewith modernizationinradiotherapy

A.VERES
EqualEstroLaboratory,VillejuifParis

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

AbriefhistoryofEqualEstro Until2004
EQUALprojectwasstartedduring1998

dedicatedtoQCinexternalradiotherapy launchedbyESTROandIGRParis supportedbytheEC

Since2004
EQUALLaboratorybecomeEqualEstrosas in2004 AccreditedbytheAFSSAPSsince2004(externalradiotherapy) AccreditedbytheCOFRACsince2009(TLDmethod) EqualEstrolaboratorycurrentlyproposedosimetryauditsin:

Conventionalexternalradiotherapy Brachytherapy IMRTandTomotherapy ComingsoonforCyberknife,Microbeamsandprotons

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

TheEqualEstroLaboratory Currentactivityofthelaboratory
Dosimetryauditsinradiotherapy
Mandatorycontrols(France) Volunteerchecks Clinicaltrials

Location
IGR Villejuif,Paris

LaboratoryTeam
1secretary 3technicians 1physicist
Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

QualityAssurance
Theaccuracyrequirementsandthemedicalconsequencesneeda dedicatedQAprogramme

InternalQA bythestaffincharge,workinginthehospital

Externalaudits withanindependentdosimetrylaboratory

Externalauditshavebeenperformedbyourlaboratory formorethan15yearsforinternationalclinicaltrials

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Measuringthedoseforexternalaudits TLDs
TLD=Thermoluminescentdosimetry

Conventionalradiotherapy

TheTLDtechniqueisoneofthemethodsemployedfordose measurements EqualEstrouseTLDs fortheauditoftheexternalbeamsaswellfor brachytherapy

PCL3,Fimel France

Linac underdosemeasurements

TLDs (tubes,powder,chips)

TLDreadingsystem Versailles, France December 2 4, 2009

ThemethodissimilartothatemployedbytheIAEA

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Measuringthedoseforexternalaudits
IMRTandTomotherapy
Filmdosimetry

Moderntechniquesofradiotherapy

Available

EasyCube phantom CompareTPSdose distributionwithfilm dosedistribution

TPS

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Film

Smallbeams(MLC)
Smallsize,solidTLDs chips EasyCube phantom

TLDchips

Inwork

Ciberknife
Filmdosimetry+TLDtubes

Protons
Filmdosimetry Orsay ProtonTherapyCenter
Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Metrology
Laboratoryinternaltests repeatability
Asetof15TLDs areirradiatedandreadbyEqualEstrolaboratory
3,00%

REPEATABILITY TEST - DTL937_NhR28

3,00%

2,50%

= 0,46%

2,00%

Standard deviation for each tube

2,00%
0,25%

0,96%

0,84% 0,30% 0,08% -0,44% -0,29% -0,44% -0,40% -0,02% -0,48% -0,03%

1,00%

1,50%

0,08% -0,56%

0,14%

0,00%

1,00%

-1,00%

0,64%

0,62%

0,50%
0,30% 0,27% 0,28%

0,42%

0,47% 0,23%

0,53% 0,40% 0,27% 0,26% 0,21% 0,14% 0,07%

-2,00%

0,00% 0 1 2 3 4 5 6 7 8 9 10 11 12 13

-3,00% 15 16

14

TLD N

Themostrecentrepeatabilitytest,performedonSeptember2009, fortheDTL937powder

TheresultisconsideredasacceptablewhenStd.dev.iswithin1% Thetestisrepeatedperiodicallyorasneeded
Versailles, France December 2 4, 2009

Deviation to the average

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Laboratoryexternalaudits intercomparisons
Co60gammabeams
Dosimetersirradiatedinourlaboratory andreadbyotherlaboratories
1,050

Dosimetersirradiatedinreferencelaboratories andreadinourlaboratory
1,050

Cobalt 60 - Equal-Estro reference source

1,030

Cobalt 60 - Equal-Estro readings

1,030

EE Dm / PL Ds
mean = 0.997 S.D.(1s) = 0.010

PL Dm / EE Ds

1,010

1,010

0,990

0,990

0,970

0,970

average = 1.000 1 standart deviaton = 0.006

0,950 IAEA - 1998 IAEA - 1999 IAEA - 2000 IAEA - 2002 IAEA - 2003 IAEA - 2004 IAEA - 2005 IAEA - 2006 UMEA - 1999 NRPI-Cz - 2003 NRPI-Cz - 2003 IAEA - 2007
IAEA - 2004 IAEA - 2005 IAEA - 2006 IAEA - 2007 IAEA - 2008

0,950 IAEA - 1998 IAEA - 1999 IAEA - 2000 IAEA - 2002 IAEA - 2003 EROPAQ - 2001 PQR-Br - 2000 ISS - 2001 NRPI-Cz - 2003 RPC - 1999 RPC - 2002 RPC - 2005

PQR - 2000

LPRI - 1999

PTW - 1999

LPRI - 2000

Participating Laboratory and date

Participating Laboratory

Ourreferencesourceistested

OurTLDreadingsystemistested

Forthelasttenyearsresultsofintercomparisons with referencecentresshow: astandarduncertaintywithin1%

Versailles, France December 2 4, 2009

UHG - 2001

UHG - 1999

PQR - 2002

RPC - 1999

ISS - 2001

RPC - 2001

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Externalauditservices
Externalradiotherapy
HighEnergyPhotonBeams:exampleofcheckedparameters ReferenceBeamOutput

DepthDoseData BeamOutputVariation WedgeTransmissionFactor

Brachytherapysystems
HDRandPDRsystemsusingIr192sources

Onepointofcheck Irradiationsusing3symmetricpositionsof
applicators

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

ACCEPTABILITYCRITERIA:measureddose/stateddose
HighEnergyPhotonBeams
DEVIATIONLEVELSontheDm/Ds() 3% > 3%to 5% > 5%to 10% > 10% withinOPTIMALLEVEL withinTOLERANCELEVEL outsideTOLERANCELEVEL EMERGENCYLEVEL Recheck Stop+Recheck OK

HDRandPDRsystems
5% > 5%to 7% > 7%to 10% > 10% withinOPTIMALLEVEL withinTOLERANCELEVEL outsideTOLERANCELEVEL EMERGENCYLEVEL Recheck Stop+Recheck
Versailles, France December 2 4, 2009

OK

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

MandatorycontrolsinFrance
externaldosimetryauditsbecamemandatoryinFrancesince2004 externalradiotherapy

supervisedbytheAFSSAPS (the FrenchHealth Products Safety Agency)

OurlaboratoryisinchargeofsuchcontrolsinFrance

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Mandatorycontrols (inFrance)
Beams controlled in the frame of AFSSAPS regulation Between October 2004 and September 2009
900 775

TOTAL Beams
800

730 - 94%

Validated for deviation < 5%

700

501 - 90%

Number of beams

500

400 203 - 87%

200

233

300

559

600

50 - 9%

513 - 90% 46 - 8% 2009

20 - 9%

30 - 4%

10 - 4%

8 - 1%

2004

2005

2006

Year

2007

5 - 1%

2008

since2004,theserious deviationshasdiminuend
Versailles, France December 2 4, 2009

7 - 1%

100

15 - 2%

41 - 6%

568

Rechecked for deviation between 5 to 10% Rechecked for deviation > 10%

682 - 94%

728

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Resultsformandatorycontrols
totalnumberofbeams,controlledsince2004:2863
Deviation() Nr.ofbeams 5% 2631 5%< 10% 187 >10% 45

6.5% 1.5% 92%

d 5% 5% < d 10% d > 10%

Morethan90%ofthecheckedbeamsfulfil the acceptabilitycriteriaafterthefirstcheck

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

Resultsofdosimetryauditsinbrachytherapy
ThecontrolswereperformedforEuropeancentres
15
11 - 1 0 0%

Brachytherapy dosimetry controls

TOTAL No of controls Validated for deviations < 7% Rechecked for deviations in the range of 7 to 10% Rechecked for deviations > 10%

11

N u m b e r o f c o n tro ls

8 - 100%

8 - 80%

10

10

10

9 - 90 %

5
2 - 20%

1 - 10%

4 - 100%

2005

2006

Year

2007

2008

2009

geometricreconstructiontestsareadditionallyproposed CollaborationbetweentheBRAPHYQS groupandEQUAL LaboratorysinceJanuary2002

Versailles, France December 2 4, 2009

0 0

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

CONCLUSIONS
EqualEstroprovideanindependentandtrustworthyverification ofdosedelivery Themetrologyisoneofmostimportantaspectsoftheactivityin EqualEstrolaboratory TheTLDmethod,asemployedbyourlaboratory,hasprovedits suitabilityinpractice Ourlaboratoryisinterestedindevelopingnewdosecontrol techniques Theexternalauditsallowsdetectingdosimetric errors Majordeviationsfordosedeliveryaredecreasing

Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

THANKSTOALLTHOSEWHOWEREINVOLVED INTHEEQUALProject:
AndreDutreix JeanChavaudra HansSvensson Andr Bridier Ivaldo Ferreira AmlieRou

THANKSTOALLTHOSEWHOCONTINUETOSUPPORT

EQUALESTRO
Versailles, France December 2 4, 2009

InternationalConference onModernRadiotherapy:

Advances and Challenges in Radiation Protection of Patients

THANKYOUFORYOURATTENTION

Versailles, France December 2 4, 2009