DIVISÃO DE FÍSICA MÉDICA PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 OUTLINE 1. 
2. 
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National characterization Autit methodology Dose intercomparison TPS input data check Non-­‐dosimetric results Dosimetric results Summary of the results 1. NATIONAL CHARACTERIZATION PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 24 RT Centres (44 LINACS) North – 7 (15 Linacs) Center – 2 (5 Linacs) Lisbon and surroundings – 12 (19 linacs) South – 2 (3 Linacs) Madeira – 1 (2 Linacs) CAPACIDADE INSTALADA ACELERADORES LINEARES
ARS Norte
ARS Centro
ARS LVT
ARS
Alentejo
ARS Algarve
H. Braga (SNS)
1 AL
HSJ (SNS)
2 AL
CUF (Privado)
1 AL
IPO Porto (SNS)
Clin. Quadrantes (Privado)
7 AL
1 AL
CRP (Privado)
2 AL
CHTMAD (Vª Real) (SNS)
1 AL
HUC (SNS)
2 AL
IPO Coimbra (SNS)
3 AL
CHLN (SNS)
4 AL
(3 HSM + 1 Privado
SAMS)
CO Nat. Chaves (Privado)
2 AL
CUF (Privado)
2 AL (Descobertas)
1 GK (Inf.Santo)
Hosp. Santarém(SNS)
1 AL (Quadrantes
Santarém)
IPO Lisboa (SNS)
2 AL
Clin St Antº(Privado)
1 AL
H. Da Luz+IRIO(Privado)
2 AL
Fund.- Champalimaud (Privado)
2 AL
CH Barreiro/Montijo (SNS)
2 AL
HOSPOR (Privado)
1 AL
Hosp. Évora (SNS)
2 AL (em PPP)
NOTA:
Quadrantes Funchal – 1 AL
Clin. Quadrantes Faro (Privado)
1 AL
Legenda:
AL – Acelerador Linear
GK - Gamaknife
PRS2013, Lisbon, 18-­‐20 September 2013 TOTAL N. OF LINACS (44) 6 Varian 8 Elekta Siemens 30 Audited Linacs (25) Siemens audited, 4 Siemens, 2 Varian , 15 Elekta audited, 6 Elekta, 2 Varian audited, 15 PRS2013, Lisbon, 18-­‐20 September 2013 Beam Energies (50) 3 2 1 14 24 6 4 MV 6 MV 10 MV 15 MV 16 MV 18 MV PRS2013, Lisbon, 18-­‐20 September 2013 TPS (25) 2 Eclipse Xio 9 14 Oncentra PRS2013, Lisbon, 18-­‐20 September 2013 ALGORITHMS (32) 3 1 9 3 Eclipse AAA Eclipse PB XiO Superposition XiO Fast superposition Oncentra CC Oncentra PB 7 9 PRS2013, Lisbon, 18-­‐20 September 2013 CHRONOLOGY OF THE PROCESS IAEA application
Voluntary registry
of RT Centres
1st phase audit
(Oct-Dec 2011)
Diffusion of
the results
2nd phase audit
(Jan-May 2012)
DFM_SPF meeting
(Jan 2011)
Kick-off Workshop and
Pilot centre audit
(Sept. 2011)
Final Workshop
And evaluation
(Jun. 2012)
2. TPS AUDIT METHODOLOGY PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 1.  Two CT scans of the phantom: 2. Planning of the 8 test-­‐cases i) to obtain the CT to ED conversion relation; corresponding to 28 dose points ii) to constitute the planning CT image set for each energy-­‐algorithm dataset 3. The irradiation phase starts with the dose intercomparison between the local reference system and the reference system of the pilot centre 4. Finally the irradiations of all 8 test-­‐
cases are performed and the results analysed 3. DOSE INTERCOMPARISON PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 Dose intercomparison 2 1.5 1 % Diff from Pilot 0.5 Center 0 1 -­‐0.5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 4 MV 6 MV 10 MV 15 MV 16 MV 18 MV -­‐1 -­‐1.5 -­‐2 -­‐2.5 4. TPS INPUT DATA CHECK PRS2013, Lisbon, 18-­‐20 September 2013 Field size PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 Field size PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 5. NON-­‐DOSIMETRIC TESTS PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 CT Scanners Philips 13% GE 37% Siemens 50% Almost all CT scanners are RT dedicated PRS2013, Lisbon, 18-­‐20 September 2013 CT to ED (Measured vs. TPS data) 120 Percentage of centers 100 80 FAIL 60 PASS 40 20 0 Air Lung Adipose Water Muscle Bone Dense bone 6. DOSIMETRIC TESTS PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 6MV_TEST CASE 1, POINT 9 5 3 4 9 10 3 2 1 Centre 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 -­‐1 -­‐2 -­‐3 -­‐4 -­‐5 -­‐6 AAA_Eclipse PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra 23 24 PRS2013, Lisbon, 18-­‐20 September 2013 15MV/18MV_TEST CASE 1, POINT 9 3 6 10 4 9 2 Centre 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 -­‐2 -­‐4 -­‐6 -­‐8 -­‐10 AAA_Eclipse PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra 23 24 PRS2013, Lisbon, 18-­‐20 September 2013 6 15MV/18MV_TEST CASE 1, POINT 10 3 4 10 9 2 Centre 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 -­‐2 -­‐4 -­‐6 AAA_Eclipse PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra 23 24 PRS2013, Lisbon, 18-­‐20 September 2013 6MV_TEST CASE 6, POINT 7 3 8 6 7 10 22 23 Centre 24 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 -­‐2 -­‐4 -­‐6 -­‐8 AAA_Eclipse -­‐10 PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra PRS2013, Lisbon, 18-­‐20 September 2013 15MV/18MV_TEST CASE 7, POINT 5, SUM 4 5 3 2 1 Centre 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 -­‐1 -­‐2 -­‐3 -­‐4 AAA_Eclipse PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra 23 24 PRS2013, Lisbon, 18-­‐20 September 2013 4 15MV/18MV_TEST CASE 8, POINT 5, SUM 5 3 2 Centre 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 -­‐1 -­‐2 -­‐3 -­‐4 AAA_Eclipse PB_Eclipse Superposition_XiO FastSuperposition_XiO PB_Oncentra CC_Oncentra 23 24 7. SUMMARY OF THE RESULTS PRS2013, Lisbon, 18-­‐20 September 2013 PRS2013, Lisbon, 18-­‐20 September 2013 SUMMARY OF THE RESULTS 1.  DOSE INTERCOMPARISON •  All centres are within -­‐0.14%±0.8% when compared with pilot 2.  TPS INPUT DATA CHECK •  Generally a very good consistency with reference data is shown for all make and
energies 3.  NON-­‐DOSIMETRIC TESTS •  General failure of CT to ED conversion in Bone and Dense Bone •  Almost all CT scanners are RT dedicated, so kVp is not a problem. •  Almost all centers use customized CTtoED curves •  No major influence in dose calculations PRS2013, Lisbon, 18-­‐20 September 2013 8.0 SUMMARY OF THE RESULTS(cont.) 4.  DOSIMETRIC TESTS 6.0 P10 P6 POST 4.0 2.0 0.0 -­‐2.0 -­‐4.0 P6 -­‐6.0 P6 P10 PRS2013, Lisbon, 18-­‐20 September 2013 CONCLUSIONS "   Radiotherapy treatments using standard 3D-­‐CRT techniques (which correspond to more than 90% of the treatments in Portugal) are delivered in Portugal according to the internationally recommended quality criteria "   The IAEA TPS audit project in Portugal having had 100% participation contributed to the strengthening of the cooperation between all centres and professionals, paving the way to further national collaborations namely concerning advanced treatment techniques which are already being used in some centres and that deserve increased attention in order to assure quality and safety to patients and professionals DIFFUSION OF THE RESULTS M.C. Lopes, “National TPS audit project”, M.C. Lopes, “Qualidade de Planeamento em Radioterapia – um projeto nacional” PRS2013, Lisbon, 18-­‐20 September 2013 It worthwhile to travel 8972 km in 6 months! ACKNOWLEDGEMENTS: To all participants in the audit: FURTHER ACKNOWLEDGEMENTS: • To the IAEA for lending the phantom • To Eduard Gershkevitsh and Ben Mijnheer for their expert advice • To Gerhard Feist, Nucletron, for important discussions • To IPOCFG, E.P.E. for acting as pilot centre and supplying the availability of the national coordinator of the project • To DFM_SPF for supporting the project • Adriana Martins and André Pereira at HESE, Évora • Ana Cavaco and Paulo Rachinhas at HUC, Coimbra • Filipa Ribeiro and Liliana Carita at IPOL, Lisboa • Manuel Sá da Costa and Sofia Macedo at CLISA, Amadora • Miguel Pontes and Andreia Bernardo at CONC, Carnaxide • Lilia and Ricardo Bento at SAMS, Lisboa • Diana Pinto at Hospital de Braga, Braga • Fernando Marques and Raquel Mota at Hosp. Santiago, Setúbal • Fernanda Ponte at DROC, Porto • Joana Vale at CRP, Porto • Joana Lencart at IPOP, Porto • Ester Gallego at CQ, Unid RT Funchal, Funchal • Sandra Ferreira and Vânia Batista at CHBM, Barreiro • Kátia Jacob at Hosp. CUF Descobertas, Lisboa • Luis Madureira and Esmeralda Poli at Hosp. Sta. Maria, CHLN, Lisboa • Mauro Trindade at CHTMAD, Vila Real • Vera Batel and Rita Figueira at Hosp. S. João, Porto • Mónica Sousa at CQ, Unid. RT Porto, Porto • Sandra Brás and Fábio Serra CQ, Unid. RT Faro, Faro • Sofia Faustino and Sara Germano at IRIO and Hosp. da Luz, Lisboa • Sandra Vieira, M. João Cardoso and Milton Rodrigues at Fund. Champ. Lisboa • Cláudio Batista and Paulo Fernandes at CQ, Unid RT Santarém, Santarém And of course, to all my colleagues at Serviço de Física Médica, IPOCFG, E.P.E.: • Armanda Matos
and the dosimetrists: • Carla Alves • Josefina Mateus
• Miguel Capela
• Tiago Ventura
• Brigida Ferreira
Ana Catarina Oliveira Fernanda Rocha Liliana Conceição João Gaspar Mary Araújo