Systematic in vivo dosimetry for quality assurance using diodes 2: Assessing radiotherapy techniques and developing an appropriate action protocol

Abstract

Purpose: Having previously reviewed the implementation of systematic in vivo dosimetry at the Norfolk and Norwich Hospital this paper examines the results of entrance dose measurements for specific sites/techniques and determines whether different action/alert protocols are required for these different categories.Methods and materials: Entrance dose measurements using p-type diodes were analysed for the following treatment categories: Breast, head and neck in beam direction shell, abdomino-pelvic and intrathoracic. A 4% tolerance was applied.Results: Mean deviations from expected dose and proportion of measurements exceeding tolerance were: Breast: +1.15%±3.04% (1SD), 238/1073≥4%; Head and neck: +0.35%±2.20% (1SD), 21/326≥4%; Abdomino-pelvic: +0.52%±2.75% (1SD), 93/712≥4%; Intrathoracic: −0.01%±2.75% (1SD), 22/119≥4%. Significant improvements in results for breast patients were noted following the introduction of a commercial breast board. The results for abdomino-pelvic patients confirmed a substantial variation in diode response under short FSD, wedged fields at 16MV (that had not been corrected for). The statistical uncertainty in dose measurement for each treatment category was calculated in order to assist determination of appropriate tolerance levels.Conclusions: A blanket tolerance of 4% was generally too low given the extent of measurement uncertainty. The relatively high number of readings outside tolerance where identification of errors was difficult/impossible resulted in inconsistent application of the action protocol. Some widening of tolerances is likely to improve quality of procedure and treatment. Appropriate action levels are recommended for each treatment category.