IAEA International Atomic Energy Agency IAEA quality audits in radiotherapy Joanna Izewska Head, Dosimetry Laboratory Dosimetry & Medical Radiation Physics Section, Division of Human Health

IAEA IAEA audits in radiotherapy SINCE 1969: IAEA/WHO TLD postal dose audits of radiotherapy beam calibration (45 years of operation): 130 countries, >2000 hospitals, >10000 beam checks SINCE 2005: Quality Assurance Team for Radiation Oncology (QUATRO) SINCE 2010: TPS end-to-end audits

IAEA 3 Currently >90% results are within 5% acceptance limit : N = 1271, m = 1.005, SD = 0.068, 92% res. within 5% : N = 10226, m = 1.008, SD = 0.08, 83% res. within 5% limit ±5%

IAEA TLD results within the 5% limit 4

IAEA TLD results: use of CoPs ( ) 126 deviations beyond 20% excluded TLD results

IAEA 6 IAEA TPS audit procedures Set of practical tests for dosimetry calculations reflecting basic treatment techniques in a typical radiotherapy hospital IAEA scientific secretary: S. Vatnitsky

IAEA IAEA supported TPS audit in Europe Eight European countries conducted TPS audits with the IAEA support Approx. 60 hospitals participated Approx. 200 datasets have been collected for beam/TPS algorithm combination Several dosimetry and TPS- related problems were identified and fixed 7

IAEA 8 Comprehensive RT audit: QUATRO

IAEA QUATRO audit procedures Auditors: RO, MP, RTT Typically 5 days per RT centre Entrance briefing Assessment: tour of facility, staff interviews, review & evaluation of procedures and documentation, measurements, tests, observation of practical work Exit briefing: feedback to the department, preliminary recommendations, questions, discussion. 9

IAEA QUATRO missions lower middle income upper middle income high income Training of auditors and regional QUATRO workshops in all regions 70 QUATRO missions to date: Africa – 6; Asia – 18; Europe – re- audits; Latin America – 13

IAEA 11 Europe: recommendations by QUATRO Support staff continuous development Strengthen QA programmes and procedures Equipment: get more, use better Increase staffing levels: MP, RO, RTT Staff requires training: RTT, RO, MP Improve treatment protocols Improve structure and organization of cancer centres

IAEA THANK YOU 12