QA Protocols Research Articles

Survey on fan-beam computed tomography for radiotherapy: Imaging for dose calculation and delineation

Background and purposeTo obtain an understanding of current practice, professional needs and future directions in the field of fan-beam CT in RT, a survey was conducted. This work presents the collected information regarding the use of CT imaging for dose calculation and structure delineation. Materials and methodsAn online institutional survey was distributed to medical physics experts employed at Belgian and Dutch radiotherapy institutions to assess the status, challenges, and future directions of QA practices for fan-beam CT. A maximum of 143 questions covered topics such as CT scanner availability, CT scanner specifications, QA protocols, treatment simulation workflow, and radiotherapy dose calculation. Answer forms were collected between 1-Sep-2022 and 10-Oct-2022. ResultsA 66 % response rate was achieved, yielding data on a total of 58 CT scanners. For MV photon therapy, all single-energy CT scans are reconstructed in Hounsfield Units for delineation or dose calculation, and a direct- or stoichiometric method was used to convert CT numbers for dose calculation. Limited use of dual-energy CT is reported for photon (N = 3) and proton dose calculations (N = 1). For brachytherapy, most institutions adopt water-based dose calculation, while approximately 26 % of the institutions take tissue heterogeneity into account. Commissioning and regular QA include eleven tasks, which are performed by two or more professions (29/31) with varying frequencies. ConclusionsDual usage of a planning CT limits protocol optimization for both tissue characterization and delineation. DECT has been implemented only gradually. A variation of QA testing frequencies and tests are reported.

Preliminary evaluation of a novel secondary check tool for intensity modulated radiotherapy treatment planning

PurposeTo evaluate the dosimetric accuracy of the Delta4 Insight (DI) secondary-check dosimetry system. MethodsAbsolute dosimetry in reference conditions, output factors, percent depth doses normalized and off-axis dose profiles for different field sizes calculated by DI were compared with measurements. Dose calculations for 20 clinical IMRT/VMAT plans generated in the TPS using both AAA or AcurosXB algorithms were compared with measurements. The average difference between calculated and measured point dose in high-dose region was calculated for all cases. 3D dose measurements were performed in Delta4 Phantom+ and a comparison between calculated and measured dose distributions was performed by means of the gamma analysis with 3 %/2 mm criteria. The dose distributions calculated by DI for 20 IMRT/VMAT plans were compared with those calculated by the TPS. ResultsThe absolute dosimetry computed by DI showed dose value in agreement with the measured one within 0.3 %. The average differences between measured and calculated output factors were less than 2.5 %. The average PDD differences were less than 0.6 %. An excellent agreement between calculations and off-axis measurements is found. The point doses calculated for the 20 recalculated plan showed good agreement with measurements with average differences less than 0.5 %. The average gamma pass rate values for the Delta4 Phantom + 3D dose analysis was greater than 97.%. The comparison of DI with theTPS showed good agreement for the used metrics. ConclusionsDelta4 Insight may provide a useful independent secondary dose verification system for IMRT/VMAT plans, complementing the traditional global QA protocols.

Testy kontroli jakości obrazowania kV-CBCT z wykorzystaniem fantomu Capthan 504 oraz ich analiza z użyciem oprogramowania Artiscan.

Radioterapia kontrolowana za pomocą obrazowania (ang. Image Guided Radiotherapy – IGRT) w ostatnich latach stała się szeroko akceptowalną i zalecaną techniką leczenia. Możliwość precyzyjnego obrazowania pacjenta bezpośrednio przed podaniem wiązki terapeutycznej pozwala na bardzo dokładne sprawdzenie jego ułożenia, precyzyjne napromienienie obszaru tarczowego oraz zmniejszenie dawki promieniowania deponowanej w zdrowych tkankach i narządach. Głównym celem pracy było wykonanie testów kontroli jakości systemu obrazowania kV-CBCT zainstalowanego na medycznym akceleratorze liniowym TrueBeam, firmy Varian Medical Systems. Celem szczegółowym było wyznaczenie wartości referencyjnych dla wszystkich testów obrazowania oraz opracowanie protokołów QA (ang. Quality Assurance). Do przeprowadzenia testów kontroli jakości wykorzystano fantom Catphan 504. Dokonano kontroli jakości dwóch protokołów skanowania: Head oraz Pelvis. Podczas testów wyznaczono następujące parametry opisujące jakość obrazu: liniowość skali jednostek Hounsfielda, rozdzielczość wysokokontrastową, rozdzielczość niskokontrastową, zniekształcenie geometryczne, poziom szumu, jednorodność. Do analizy uzyskanych obrazów DICOM wykorzystano oprogramowanie Artiscan. Poziom szumu w obrazie wynosił 2,75% dla protokołu skanowania Head i 0,85% dla protokołu Pelvis, natomiast jednorodność obrazu wynosiła 94% i 98%. Wszystkie obliczone wartości jednostek HU mieściły się w przyjętym przedziale tolerancji. Rozdzielczość wysokokontrastowa wynosiła kolejno 7,70lp/mm i 5,59lp/mm. Dla protokołu skanowania Pelvis, obiekt o średnicy 15mm w warunkach Supra-Slice 1% został wykryty podczas każdej serii pomiarowej. Nie zaobserwowano żadnych zniekształceń geometrycznych obrazu. Opracowane protokoły kontroli jakości używane są w praktyce klinicznej podczas procesu kontroli jakości.

360. Paramed MR Open installation: Customized quality assurance protocol and safety issues

Purpose MR Open produced by Paramed is an open MRI total body scanner, with a static maximum field of 0,5 T, and a superconducting MgB2 coils system, not requiring a liquid helium bath. A recent installation in ASSL Sassari has permitted to investigate the performance of the scanner and a different approach to safety problems. Methods and materials MGB2 is an intermetallic superconductor (Tc 39 K, instead of about 10 K for Nb-Ti classical magnets) recently used in MRI, through two cryocooling systems exploiting a small amount of helium gas in two closed-loops. Our MR open has an open magnet, and is equipped with 10 different multichannel coils, addressed to patients’ multiposition and weight-bearing studies, while cardiac and breast studies are not permitted. The scanner is suitable for claustrophobic and wheelchair patients. A specific quality assurance protocol has been assessed for each coil, according to EUROSPIN, NEMA, and AAPM guidelines. EUROSPIN phantoms have been used in general, but two ESAOTE (not PARAMED) phantoms have proved useful for the smaller coils. Results The amount of helium was judged safe: even in case of total dispersion, oxygen level wouldn’t drop down 20,6%: unexpected quench problems are substantially fictitious, no quench line and oxygen sensor are needed. Magnetic fringe field is quite high. The possibility to quickly switch off the static field should be managed carefully, even in case of accident: the hazard of high induced currents should be considered. The quality parameters resulted within AAPM tolerances for all the coils, SNR values were determined according to NEMA and kept as reference, maximum ghosting resulted in 2,5%, higher than usual. Conclusion Safety and QA protocols must be fit to the particular facility. The comprehensive phantom set resulted quite appropriate, except for the spatial resolution with small coils (only 2 mm possible measure). Ghost is generally not negligible. MR Open produced by Paramed is an open MRI total body scanner, with a static maximum field of 0,5 T, and a superconducting MgB2 coils system, not requiring a liquid helium bath. A recent installation in ASSL Sassari has permitted to investigate the performance of the scanner and a different approach to safety problems. MGB2 is an intermetallic superconductor (Tc 39 K, instead of about 10 K for Nb-Ti classical magnets) recently used in MRI, through two cryocooling systems exploiting a small amount of helium gas in two closed-loops. Our MR open has an open magnet, and is equipped with 10 different multichannel coils, addressed to patients’ multiposition and weight-bearing studies, while cardiac and breast studies are not permitted. The scanner is suitable for claustrophobic and wheelchair patients. A specific quality assurance protocol has been assessed for each coil, according to EUROSPIN, NEMA, and AAPM guidelines. EUROSPIN phantoms have been used in general, but two ESAOTE (not PARAMED) phantoms have proved useful for the smaller coils. The amount of helium was judged safe: even in case of total dispersion, oxygen level wouldn’t drop down 20,6%: unexpected quench problems are substantially fictitious, no quench line and oxygen sensor are needed. Magnetic fringe field is quite high. The possibility to quickly switch off the static field should be managed carefully, even in case of accident: the hazard of high induced currents should be considered. The quality parameters resulted within AAPM tolerances for all the coils, SNR values were determined according to NEMA and kept as reference, maximum ghosting resulted in 2,5%, higher than usual. Safety and QA protocols must be fit to the particular facility.

Abstract ID: 373 Quality assurance (QA) in unconventional magnetic resonance (MR) techniques: Diffusion and spectroscopy

Purpose Diffusion-weighted imaging (DWI) is an MR quantitative technique, which is widely employed in research applications as well as in clinical practice. Proton MR Spectroscopy (MRS) in vivo provides unique biochemical information that complements MR imaging. Specific test objects and evaluation methods should be used to obtain meaningful information on the performance level of the MR scanner, and the need for QA protocols also in DWI and MRS acquisitions is well recognized by international guidelines. The aim of this work is to present the methods for measuring the main parameters for the evaluation of the quantitative accuracy of diffusion and spectroscopy techniques. Methods Methods to assess the reliability of the spectroscopic chain should include at least the measurement of the signal-to-noise ratio and the characterization of a singlet resonance peak such as that of water or a metabolite (intensity, spectral resolution), the accuracy of spatial selectivity (linearity test) in single or multi-volume mode and finally the efficiency of water-suppression pulses. It is also advisable to check the degree of accuracy of the absolute quantification by verifying the concentration of a mixture of metabolites by means of calculation algorithms available on the console or in offline mode. In DWI, the apparent diffusion coefficient (ADC) is a physical quantity calculated directly from a series of images obtained with different diffusion weighing (b-value) due to the application of high intensity field gradients. ADC is affected by different factors that may increase its inaccuracy and variability (gradient miscalibration and spatial nonlinearity, coupled imaging-gradient, rectified noise, temperature). It is advisable to plan a series of diffusion-weighted acquisition sequences of a phantom containing an aqueous/gelatinous solution and equipped with a temperature verification system. DWI acquisition series should be performed with both short and long maximum b-value, changing the spatial direction of the gradients applied at least along the three main orthogonal axes. Finally, more advanced tests can be devised for the evaluation of parameters derived from the diffusion tensor such as fractional anisotropy or kurtosis index, using isotropic/anisotropic phantoms and suitably heterogeneous materials (non-gaussian diffusion), respectively. Diffusion-weighted imaging (DWI) is an MR quantitative technique, which is widely employed in research applications as well as in clinical practice. Proton MR Spectroscopy (MRS) in vivo provides unique biochemical information that complements MR imaging. Specific test objects and evaluation methods should be used to obtain meaningful information on the performance level of the MR scanner, and the need for QA protocols also in DWI and MRS acquisitions is well recognized by international guidelines. The aim of this work is to present the methods for measuring the main parameters for the evaluation of the quantitative accuracy of diffusion and spectroscopy techniques. Methods to assess the reliability of the spectroscopic chain should include at least the measurement of the signal-to-noise ratio and the characterization of a singlet resonance peak such as that of water or a metabolite (intensity, spectral resolution), the accuracy of spatial selectivity (linearity test) in single or multi-volume mode and finally the efficiency of water-suppression pulses. It is also advisable to check the degree of accuracy of the absolute quantification by verifying the concentration of a mixture of metabolites by means of calculation algorithms available on the console or in offline mode. In DWI, the apparent diffusion coefficient (ADC) is a physical quantity calculated directly from a series of images obtained with different diffusion weighing (b-value) due to the application of high intensity field gradients. ADC is affected by different factors that may increase its inaccuracy and variability (gradient miscalibration and spatial nonlinearity, coupled imaging-gradient, rectified noise, temperature). It is advisable to plan a series of diffusion-weighted acquisition sequences of a phantom containing an aqueous/gelatinous solution and equipped with a temperature verification system. DWI acquisition series should be performed with both short and long maximum b-value, changing the spatial direction of the gradients applied at least along the three main orthogonal axes. Finally, more advanced tests can be devised for the evaluation of parameters derived from the diffusion tensor such as fractional anisotropy or kurtosis index, using isotropic/anisotropic phantoms and suitably heterogeneous materials (non-gaussian diffusion), respectively.

9.4\xa0T small animal MRI using clinical components for direct translational studies

BackgroundMagnetic resonance is a major preclinical and clinical imaging modality ideally suited for longitudinal studies, e.g. in pharmacological developments. The lack of a proven platform that maintains an identical imaging protocol between preclinical and clinical platforms is solved with the construction of an animal scanner based on clinical hard- and software.MethodsA small animal magnet and gradient system were connected to a clinical MR system. Several hardware components were either modified or built in-house to achieve compatibility. The clinical software was modified to account for the different field-of-view of a preclinical MR system. The established scanner was evaluated using clinical QA protocols, and platform compatibility for translational research was verified against clinical scanners of different field strength.ResultsThe constructed animal scanner operates with the majority of clinical imaging sequences. Translational research is greatly facilitated as protocols can be shared between preclinical and clinical platforms. Hence, when maintaining sequences parameters, maximum similarity between pulses played out on a human or an animal system is maintained.ConclusionCoupling of a small animal magnet with a clinical MR system is a flexible, easy to use way to establish and advance translational imaging capability. It provides cost and labor efficient translational capability as no tedious sequence reprogramming between moieties is required and cross-platform compatibility of sequences facilitates multi-center studies.

The need to identify occupational exposure to laser radiation in greece

Introduction Optical radiation, part of the non-ionizing spectrum, covers the UV, the IR and the visible regions. The relevant occupational exposure legislation, Directive 2006/25/EC, employs limits and Occupational Health & Safety (OHS) regulations for laser (coherent) and non-coherent artificial optical radiation (AOR). Purpose Although ten years have passed from the release of the aforementioned Directive, poor progress has been made for its practical implementation, mainly regarding the risk assessment by a qualified expert. The Hellenic Ministry of Labor, following a non-coherent AOR survey, in conjunction with the National Technical University of Athens and the Greek Atomic Energy Commission took the initiative to identify the field. Materials and methods Lasers are widespread mainly in health care facilities, industry, cosmetic applications, research and entertainment, but there is no homogenized safety approach countrywide. Selected workplaces have been chosen for evaluation of their OHS applied and for measurement of the appropriate optical quantities. The role of the Laser Safety Officer has been discussed as well. Results Mapping of the extent of laser applications in Greece has been performed together with an initial testing of selected crucial workplaces, as representative pilot studies. Major challenge and objective is the development of dedicated risk assessment checklists and of QA protocols for laser applications, further specified for medical applications. Conclusion The creation of a national occupational exposure database and of approved safety and QA protocols for laser procedures seems reasonable after the collaboration of the involved Authorities. Disclosure Authors disclose that they don’t have any relationship that may bias their presentation.

Development and implementation of a DQE technique to assess image quality for digital radiology systems in the Saolta University Healthcare Group

Detective quantum efficiency (DQE) historically has been a commonly used metric to assess overall image quality of radiographic systems. It is defined as the ratio of the squared image signal-to-noise ratio to the number of incident X-ray photons. The DQE describes how efficiently a system translates incident X-ray photons into useful signal (relative to noise) within an image. However it is a relatively complex technique and therefore very few Medical Physicists working in Diagnostic Imaging Departments actually use the technique in practice and instead apply QA protocols based on sets of Imaging test objects whose results are prone to observer subjectivity. In 2003, the International Electrotechnical Commission (IEC) published a standard method for measurement of the DQE that also included specifications for the measurement of two associated metrics: Modulation Transfer Function (MTF) and Noise Power Spectrum (NPS). Based on this IEC standard and other published literature we developed a technique to measure MTF, NPS and DQE “in the field”. In this paper we will present a summary of the methodology and some initial findings from the assessment of flat panel detector based Digital Radiography systems will be presented and explored.

SU‐E‐T‐617: Plan Quality Estimation of Intensity‐Modulated Radiotherapy Cases for Lung Cancer

Purpose:To estimate the planning quality of intensity‐modulated radiotherapy in lung cancer cases and to provide preliminary data for the development of a planning quality assurance algorithm.Methods:42 IMRT plans previously used in cases of solitary lung cancers were collected. Organs in or near the thoracic cavity, such as lung (ipsilateral, contralateral), heart, liver, esophagus, cord and bronchus were considered as organs at risk (OARs) in this study. The coverage index (CVI), conformity index (CI), homogeneity index (HI), volume, irregularity (standard deviation of center‐surface distance) were used to compare PTV dose characteristics. The effective uniform dose (EUD), V10Gy, and V20Gy of the OARs were used to compare OAR dose characteristics.Results:Average CVI, CI, HI values were 0.9, 0.8, 0.1, respectively. CVI and CI had narrow Gaussian distribution curves without a singular value, but one case had a relatively high (0.25) HI because of location and irregular shape (Irregularity of 18.5 when average was 12.5) of PTV. EUDs tended to decrease as OAR‐PTV distance increased and OAR‐PTV overlap volume decreased.Conclusion:This work indicates the potential for significant plan quality deviation of similar lung cancer cases. Considering that this study were from a single department, differences in the treatment results for a given patient would be much more pronounced if multiple departments (and therefore more planners) were involved. Therefore, further examination of QA protocols is needed to reduce deviations in radiation treatment planning.

Long-term stability of the MR system of the Philips Ingenuity TF

The Philips Ingenuity TF is a sequential PET/MR with an Achieva 3T X-series MR and Gemini TF PET system connected with a rotating table. Both the PET and MR systems are designed to minimize mutual system interference. However, a longitudinal study concerning the stability of the MR system has not been conducted before. The stability of the MR system affects diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and functional MRI (fMRI), especially in longterm and multi-center studies. In addition, the variation of geometric distortions and consistency of MR image quality is important for clinical studies and radiotherapy planning. The long-term stability of the MR system was monitored by weekly quality control (QC) scans during one year. For measuring DWI, DTI and fMRI stability, protocols from fBIRN and vendor QA were implemented by using a spherical agar phantom and a liquid sphere phantom. For measuring the variations of image quality, ACR phantom measurements were performed. For the fBIRN and vendor QA protocols, automatic QC programs provided by the consortium and manufacturer were used. For the ACR phantom, an automatic quality control measurement was developed in MATLAB 2011b. Analysis of the QC scans did not show any significant variations with the fBIRN, vendor QA or ACR protocols. Thus, the MR system of the Ingenuity TF was deemed to be stable in the longitudinal study. Automated analysis of QC measurements was deemed necessary for implementing multiple, weekly measurements for PET/MR.

Poster — Thur Eve — 27: Flattening Filter Free VMAT Quality Assurance: Dose Rate Considerations for Detector Response

Introduction:Radiation detector responses can be affected by dose rate. Due to higher dose per pulse and wider range of mu rates in FFF beams, detector responses should be characterized prior to implementation of QA protocols for FFF beams. During VMAT delivery, the MU rate may also vary dramatically within a treatment fraction. This study looks at the dose per pulse variation throughout a 3D volume for typical VMAT plans and the response characteristics for a variety of detectors, and makes recommendations on the design of QA protocols for FFF VMAT QA.Materials and Methods:Linac log file data and a simplified dose calculation algorithm are used to calculate dose per pulse for a variety of clinical VMAT plans, on a voxel by voxel basis, as a function of time in a cylindrical phantom. Diode and ion chamber array responses are characterized over the relevant range of dose per pulse and dose rate.Results:Dose per pulse ranges from <0.1 mGy/pulse to 1.5 mGy/pulse in a typical VMAT treatment delivery using the 10XFFF beam. Diode detector arrays demonstrate increased sensitivity to dose (+./− 3%) with increasing dose per pulse over this range. Ion chamber arrays demonstrate decreased sensitivity to dose (+/− 1%) with increasing dose rate over this range.Conclusions:QA protocols should be designed taking into consideration inherent changes in detector sensitivity with dose rate. Neglecting to account for changes in detector response with dose per pulse can lead to skewed QA results.

SU‐E‐T‐189: A Protocol for 3D IMRT Quality Assurance of Prostate Radiotherapy

Purpose: Define a set of statistical parameters and plan structures that will characterize the pass/fail criteria for a 3D prostate pre‐treatment IMRT quality assurance protocol. Methods: For this study, 3D IMRT QA measurements were performed on thirteen IMRT prostate patients. All plans were for an initial treatment course to the prostate and the seminal vesicles with prescription dose of 45Gy, and planned with step‐and‐shoot IMRT. All patients plans passed traditional QA methods, including point measurement with ion chamber and 2D gamma analysis at 3mm/3%. A total of 75 3D IMRT QA measurements were performed on all patients, on different days and on different beam matched linear accelerators. IBA COMPASS system was used for 3D QA measurements. For each patient, nine structures of interest were selected: femoral heads, two planning target volumes (PTV1, PTV2), prostate, seminal vesicles, anterior and posterior rectal wall and bladder. For each structure the following statistical parameters were evaluated: average dose, 3D gamma test, volume at 4% and 6% difference, and volume that receives between 5%‐105% of the prescription dose. Two QA protocols are proposed, a conservative with pass/fail QA thresholds the maximum of these 75 passing measurements; standard protocol with pass/fail QA threshold value at the maximum of the 75 measurements +50% increase. Results: Out of the 153 statistical parameters investigated, 65 were excluded from the QA protocol. The reason is that their values were constant for all 75 measurements. Assessment of the validity of the conservative protocol and standard protocol are ongoing. Conclusion: 3D IMRT QA is a powerful and versatile tool for pre‐treatment prostate IMRT QA, with ability to perform variety of statistical tests and overlay dose and anatomy. However, because 3D QA provides more information than single ion chamber measurement and/or 2D gamma analysis, a protocol is needed to establish pass/fail thresholds.

Laboratory malaria diagnostic capacity in health facilities in five administrative zones of Oromia Regional State, Ethiopia

Quality laboratory services are a requisite to guide rational case management of malaria. Using a pre-tested, standardized assessment tool, we assessed laboratory diagnostic capacity in 69 primary, secondary and tertiary health facilities as well as specialized laboratories in five administrative zones in Oromia Regional State, Ethiopia, during February and March 2009. There was marked variability in laboratory diagnostic capacity among the facilities assessed. Of 69 facilities surveyed, 53 provided both comprehensive malaria laboratory diagnosis and outpatient treatment services, five provided malaria microscopy services (referring elsewhere for treatment), and 11 primary care health posts provided rapid diagnostic testing and outpatient malaria treatment. The facilities' median catchment population was 39, 562 and 3581 people for secondary/tertiary and primary health facilities, respectively. Depending on facility type, facilities provided services 24 hrs a day, had inpatient capacity, and access to water and electricity. Facilities were staffed by general practitioners, health officers, nurses or health extension workers. Of the 58 facilities providing laboratory services, 24% of the 159 laboratory staff had received malaria microscopy training in the year prior to this survey, and 72% of the facilities had at least one functional electric binocular microscope. Facilities had variable levels of equipment, materials and biosafety procedures necessary for laboratory diagnosis of malaria. The mean monthly number of malaria blood films processed at secondary/tertiary facilities was 225, with a mean monthly 56 confirmed parasitologically. In primary facilities, the mean monthly number of clinical malaria cases seen was 75, of which 57 were tested by rapid diagnostic test (RDTs). None of the surveyed laboratory facilities had formal quality assurance/quality control protocols for either microscopy or RDTs. This is the first published report on malaria diagnostic capacity in Ethiopia. While our assessment indicated that malaria laboratory diagnosis was available in most facilities surveyed, we observed significant gaps in laboratory services which could significantly impact quality and accessibility of malaria diagnosis, including laboratory infrastructure, equipment, laboratory supplies and human resources.

MO‐A‐210A‐01: Update On Fluoroscopy Physics

Radiation usage during fluoroscopically guided interventions can be high enough to warrant careful dosimetry and patient management. Basic compliance with the usual set of local regulatory requirements is sufficient for patient safety in the interventional environments. For example, modern systems meeting all current regulatory dose restrictions are capable of delivering table‐top air kerma rates exceeding 200 mGy/min for normal mode fluoroscopy and 1,500 mGy/min for cinefluorography.Clinical dosimetry during each complex intervention is facilitated by dosimetric instrumentation built into the fluoroscopic system. The Society of Interventional Radiology has published a standard of practice recommending dosimetry for all interventional procedures. In 2008, the ACR published a technical standard for the use of radiation in fluoroscopic procedures. A DICOM Structured Report for detailed reporting of radiation usage in interventional fluoroscopy has been defined, tested and is currently being deployed in clinical systems. The Joint Commission has included fluoroscopic procedures with skin doses exceeding 15 Gy in its list of sentinel events; with the implicit challenge to facilities that they can prove the absence of such occurrences.This course reviews technical elements for a program of patient fluoroscopic radiation safety. ICRU diagnostic dosimetric quantities and their fluoroscopic extensions. Construction, dosimetric features, and performance characteristics of modern fluoroscopes. Extended QA protocols for compliance measurements, system characterization and clinical dosimetry. Dose recording and reporting, including DICOM‐DOSE. The Joint Commission fluoroscopy sentinel event.Learning Objectives1. Understand dosimetric concepts relating to interventional fluoroscopy2. Characterize the dosimetric features and performance of a modern fluoroscope3. Be able to set up a clinical dose recording and reporting policy that will meet clinical and JC requirements.

TU‐A‐352‐01: Fluoroscopic Dose Measurement and Management

Radiation usage during fluoroscopically guided interventions can be high enough to warrant careful dosimetry and patient management. Basic compliance with the usual set of local regulatory requirements may not be sufficient for patient safety. Many of these rules date back to an era in which fluoroscopy was used for simple diagnostic procedures. The X‐ray tubes of this earlier era often overloaded and shut down before dangerous doses were delivered. Neither of these suppositions are currently valid. For example, modern systems meeting all regulatory dose restrictions are capable of delivering table top air kerma rates exceeding 200 mGy/min for normal mode fluoroscopy and 1,500 mGy/min for cinefluorography.Clinical dosimetry during each complex intervention is facilitated by dosimetric instrumentation built into the fluoroscopic system. The FDA now requires such instrumentation in all new fluoroscopes. The Society of Interventional Radiology has published a standard of practice recommending dosimetry for all interventional procedures. The DICOM‐DOSE project, a joint initiative of DICOM and the IEC will shortly provide tools for automated dose reporting. The Joint Commission has included fluoroscopic procedures with skin doses exceeding 15 Gy in its list of sentinel events; with the implicit challenge to facilities that they can prove the absence of such occurrences.This course reviews technical elements needed in a program of patient fluoroscopic radiation safety. Key concepts include: ICRU diagnostic dosimetric quantities and their fluoroscopic extensions FDA and IEC compliance measurements.Construction dosimetric features, and performance of modern fluoroscopes Extended QA protocols for compliance measurements, system characterization and clinical dosimetry. Dose recording and reporting, including DICOM‐DOSE. The Joint Commission fluoroscopy sentinel event.Educational Objectives:1. Understand dosimetric concepts relating to interventional fluoroscopy.2. Characterize the dosimetric features and performance of a modern fluoroscope.3. Be able to set up a clinical dose recording and reporting policy that will meet clinical and JC requirements.

Protokół terapeutyczny w dokumentowaniu procesu napromieniania pacjentów w zakładzie radioterapii

Summary A decision to start radiotherapy should be based on at least two documents: 1. Written standards of obligatory clinical procedures which are in fact radiotherapeutic schemes. 2. Therapeutic protocols describing all mandatory procedures performed to ensure a safe and proper treatment of the patient. The range of activities described in the therapeutic protocol is very wide. It includes all initial procedures implemented in the simulation room, the CT scanner, in the treatment planning system and the mould- room, and it describes the verification process of the treatment plan, mandatory to start radiotherapy. The therapeutic protocol describes in details what and how should be checked by an internal control system and it qualifies the demands required to sum up the treatment and its’ accordance with the planned radiotherapy scheme. All the activities performed are recorded in a QA protocol, which is an integral part of the therapeutic protocol. In this paper we present the therapeutic protocol in force in the Regional Oncological Hospital in Szczecin and the QA and in-vivo protocols, which assure safe radiotherapy of the patient.