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Multi-Institutional Study for IMRT Dose Quality Assurance in Korea. Sung- Joon Ye , Jung-in Kim and IlHan Kim sye@snu.ac.kr. Radiation Oncology/Physics Seoul National University College of Medicine Seoul, KOREA. Background. Increasing role of radiotherapy on cancer management
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Multi-Institutional Study for IMRT Dose Quality Assurance in Korea Sung-Joon Ye, Jung-in Kim and IlHan Kim sye@snu.ac.kr Radiation Oncology/Physics Seoul National University College of Medicine Seoul, KOREA
Background • Increasing role of radiotherapy on cancer management • RT combined with emerging technologies; IMRT, SBRT, SRS, Proton/Carbon RT • In Korea, 40% of cancer patients under RT • Increasing chance of irreparable damage • 2005US NYC St. Vincent’s Hosp.: IMRT 7 times overdose> death • 2006UK Glasgow Beatson Cancer Center: 3DCRT 65% overdose > death • 2005-6US Florida Moffitt Center: SRS 50% overdose > not release yet or ?? Howabout the underdose? > not control tumors
Efforts for IMRT Quality Assurance IAEA, AAPM, ASTRO, ESTRO
What’s happening in Korea Korea is an early-user of advanced RT technologies but, how about the infra of RT quality assurance & safety • Daily No. of patients per RT machine: 30-35 in US vs. 40-60 in Korea • No. of physicists per RT machine: 1.0 in US vs. 0.4 in Korea • In July 2011, Governmental approval of IMRT reimbursement for health insurance programs
Purpose • Strengthen the National Infrastructure for RT QA & Medical Radiation Safety • Special emphasis on IMRT QA • Disseminate a basic protocol & guideline of IMRT Dose QA (DQA) via multi-institutional study • Derive the national tolerance (confidential limit) & action levels for IMRT commissioning
Korean MOCK Structures* • Head & Neck target • Multi-target • Prostate target • C shape target PTV 3.5 cm 4 cm Bladder H&N PTV 2.5 cm 2 cm RT parotid LT parotid Superior Target 4.2 cm 25 Gy (50%) Prostate (CTV) Core 4 cm Central Target RT Femur LT Femur Prescription dose : 50 Gy 2 cm diameter 4.2 cm 0.5 cm Cord PTV Rectum Inferior Target 4.2 cm 12.5 Gy (25%) *based on AAPM TG 119
DQA for 2D Dose Distributions RTP Film
Results *3%/3mm gamma criteria
Discussion & Conclusions • Application • Below the tolerance level: suitable for high quality RT • Exceed the action level: appropriate action should be taken ASAP • Between the tolerance & action levels: depending on further investigation • LINAC & TOMO groups have similar levels but TOMO has a bit tighter in low dose point • The results of Korea Multi-institutional study are comparable to AAPM/ESTRO guidelines
Symposium on Medical Physicists’ Role for Quality Assurance & Radiation Safety October 29, 2009
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