Achieving Quality in Brachytherapy

Cover -- Half Title -- Title Page -- Copyright Page -- Dedication -- Table of Contents -- PREFACE -- 1 GENERAL CONSIDERATIONS IN QUALITY MANAGEMENT INBRACHYTHERAPY -- 1.1 Importance of quality assurance -- 1.2 Principles of quality assurance -- 1.3 Error -- 1.3.1 Systematic error -- 1.3.2 Random error -- 1.4 Error reduction -- 1.4.1 Error prevention -- 1.4.2 Error detection -- 1.4.3 Guidance in the use of tools -- 1.5 Training -- 1.6 Staffing -- 1.7 Items not covered -- 1.8 Terminology revisited -- 1.9 Sources for information -- 1.10 Human performance implications for quality management -- 1.11 Summary -- 2 QUALITY MANAGEMENT FOR MANUAL LOADING, LOW DOSE RATE BRACHYTHERAPY SOURCES -- 2.1 Sources for a permanent inventory -- 2.1.1 Acceptance tests -- 2.1.2 Periodic tests -- 2.2 Sources ordered for particular patients -- 2.2.1 Integrity -- 2.2.2 Linear uniformity-wire (not seeds, which are too shortto matter) -- 2.2.3 Assay of source strength -- 2.2.4 Penetration and dose distribution -- 2.3 Summary -- 3 QUALITY MANAGEMENT FOR A TREATMENT PLAN -- 3.1 Evaluating whether the plan contains errors -- 3.1.1 Direct checks on the input data -- 3.1.2 Does the plan make sense? -- 3.1.3 Indirect checks on the input data -- 3.2 Evaluating the appropriateness of the plan -- 3.2.1 Concerns in evaluating the appropriateness of a treatmentplan -- 3.2.2 Tools -- 3.3 Summary -- 4 QUALITY MANAGEMENT FOR MANUALLY LOADED, LOW DOSE RATE APPLICATIONS -- 4.1 Applications involving sources from a standing inventory -- 4.1.1 Source loading -- 4.1.2 Calculation of the removal time -- 4.1.3 During the treatment -- 4.1.4 At the removal -- 4.2 Applications involving temporary sources ordered for the treatment -- 4.2.1 Source loading -- 4.2.2 Calculation of the removal time -- 4.2.3 During the treatment -- 4.2.4 At the removal

4.3 Applications involving sources ordered for a permanent implant -- 4.3.1 Source strength check -- 4.3.2 Source position checks -- 4.4 Implants using radium or caesium needles -- 4.5 Summary -- 5 QUALITY MANAGEMENT FOR HIGH DOSE RATE UNITS -- 5.1 Periodic evaluations (at the beginning of each treatment day) -- 5.1.1 Safety checks -- 5.1.2 Dosimetry checks -- 5.2 Initial checks -- 5.2.1 Safety checks -- 5.2.2 Dosimetry checks -- 5.2.3 Ancillary device checks -- 5.3 Acceptance testing and commissioning -- 5.3.1 Operation -- 5.3.2 Detection of obstructions -- 5.3.3 Source retraction-automatic (emergency) -- 5.3.4 Source retraction-manual -- 5.3.5 Loss of source -- 5.4 Checks during treatment -- 5.5 Checks after treatment -- 5.6 Summary -- Appendix 5A. Pulsed dose rate units -- 6 QUALITY MANAGEMENT FOR HIGH DOSE RATE TREATMENT PLANS -- 6.1 Error prevention -- 6.1.1 Protocols -- 6.1.2 Forms -- 6.1.3 Independent second person -- 6.2 Error detection -- 6.2.1 Independent physicist's review -- 6.2.2 Physician's review -- 6.2.3 Predelivery checks -- 6.3 Indicators of 'reasonableness' -- 6.3.1 Gynaecological intracavitary insertions -- 6.3.2 Intraluminal insertions -- 6.3.3 Interstitial implants -- 6.4 When the checks fail -- 6.5 Summary -- Appendix 6A. Some recommendations from the report of TaskGroup 59 of the American Association of Physicists in Medicine -- 7 QUALITY MANAGEMENT FOR LOW AND MEDIUM DOSE RATEREMOTE AFTERLOADERS -- 7.1 Advanced remote after loaders -- 7 .1.1 Checks per patient -- 7 .1.2 Periodic checks -- 7.2 Basic remote afterloaders -- 7 .2.1 Checks per patient -- 7 .2.2 Periodic checks -- 7 .2.3 Procedural quality considerations with basic remote afterloaders -- 7 .2.4 Reported operational problems with LDR remoteafterloaders -- 7.3 Simple source loaders -- 7.4 Dose rate considerations -- 7.5 Summary

8 QUALITY MANAGEMENT FOR BRACHYTHERAPY APPLIANCES -- 8.1 Intracavitary applicators -- 8.1.1 Gynaecological appliances -- 8.2 Intraluminal applicators -- 8.3 Interstitial equipment -- 8.3.1 Source-holding needles -- 8.3.2 Catheters -- 8.3.3 Flexible needles and fixed-length plastic tubes -- 8.3.4 Templates -- 8.4 Surface applicators -- 8.4.1 Eye applicators -- 8.4.2 Skin applicators -- 8.4.3 Intraoperative applicators -- 8.5 Summary -- 9 QUALITY MANAGEMENT FOR DOSIMETRIC TREATMENT PLANNING -- 9.1 Localization -- 9.1.1 Radiographic localization -- 9.1.2 Sectionallocalization -- 9.1.3 Ultrasound localization -- 9.1.4 Source simulation -- 9.2 Dose calculation -- 9.2.1 Digitization -- 9.2.2 Geometric reconstruction -- 9.2.3 Dose calculation -- 9.2.4 Plan output -- 9.3 Summary -- Appendix 9A -- REFERENCES -- INDEX