1. IAEA E-learning Program
Safety and Quality in Radiotherapy

2. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Sections:
11.1 On-line resources at the IAEA
11.2 IAEA’s Postal Dosimetry Audit
11.3 Quality Assurance Team for Radiation Oncology (QUATRO)
11.4 Other resources

3. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Sections:
11.1 On-line resources at the IAEA
11.2 IAEA’s Postal Dosimetry Audit
11.3 Quality Assurance Team for Radiation Oncology (QUATRO)
11.4 Other resources
In this section we will discuss the IAEA’s postal dosimetry audit program.

4. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
OBJECTIVES
To briefly review the reasons for participating in a dosimetry audit.
To outline how the IAEA programme works.
To examine the success of the IAEA Postal Dosimetry programme.
Here is what we will do in this section. We will briefly review the reasons for participating in a dosimetry audit, outline how the IAEA programme works and then we will examine the success of the IAEA’s Postal Dosimetry Programme.

5. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
OBJECTIVES
To briefly review the reasons for participating in a dosimetry audit.
To outline how the IAEA programme works.
To examine the success of the IAEA Postal Dosimetry programme.
Now, we will review the reasons for participating in a dosimetry audit.

6. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
IAEA’s Postal Dosimetry Audit: Why?
Optimum, safe radiotherapy is predicated on delivering the correct dose to the correct anatomical region whilst sparing normal, non-cancerous tissue.
Why is a Postal Dosimetry Audit useful? Optimum, safe radiotherapy is predicated on delivering the correct dose to the correct anatomical region whilst sparing normal, non-cancerous tissue.

7. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
IAEA’s Postal Dosimetry Audit: Why?
Optimum, safe radiotherapy is predicated on delivering the correct dose to the correct anatomical region whilst sparing normal, non-cancerous tissue.
Clearly, the correct dose will not be delivered if the equipment delivering that dose is not properly calibrated.
Whatever the skill and resource level of any particular centre, there is always a chance that a treatment machine will be incorrectly calibrated.
Clearly, the correct dose will not be delivered if the equipment delivering that dose is not properly calibrated. However, we should note in passing that while a correctly calibrated linac or Cobalt unit is a necessary condition for accurate dosimetry it is not, on its own, sufficient. It would still be possible for monitor unit or time calculations to be performed incorrectly. But with an incorrectly calibrated machine, delivery of the incorrect dose is inevitable.
Whatever the skill and resource level of any particular centre, there is always a chance that a treatment machine will be incorrectly calibrated with potentially disastrous results for patients. This is why an independent dosimetry audit is so valuable.

8. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
Training (7)
Staffing/skills mix (6)
Documentation/SOP (5)
Incident Learning System (5)
Communication/questioning (4)
Check lists (4)
QC and PM (4)
Dosimetric Audit (4)
Accreditation (4)
Minimizing interruptions (3)
Prospective risk assessment (3)
Safety Culture (3)
To reinforce the importance of independent dosimetric audits, we recall from the first module in this e-learning program that such audits are widely recognized by experts in the field as being a powerful safety measure.

9. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
OBJECTIVES
To briefly review the reasons for participating in a dosimetry audit.
To outline how the IAEA programme works.
To examine the success of the IAEA Postal Dosimetry programme.
Next, we will outline how the IAEA dosimetry audit programme works.

10. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
IAEA’s Postal Dosimetry Audit
The importance of an independent dosimetry audit in radiotherapy was recognized by the IAEA as long ago as 1969 when, in collaboration with the World Health Organization (WHO), the postal dosimetry audit programme was initiated.
The importance of an independent dosimetry audit in radiotherapy was recognized by the IAEA as long ago as 1969 when, in collaboration with the World Health Organization, the postal dosimetry audit programme was initiated.

11. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How does it work?
On request, and with approval, the IAEA will send you a number of TLD capsules, together with appropriate holders and detailed instructions for use to a participating centre.
So, how does the programme work? On request, and with approval, the IAEA will send you a number of TLD capsules, together with appropriate holders and detailed instructions for use to a participating centre.

12. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
TLD Training Video
The IAEA provides a training video to help the audited centre fully understand how the TLD dosimeters are to be used.
Step-by-step explanation with example of operation
18 minutes, HD quality, 3 languages (ENG, SPA, RUS)

13. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How does it work?
The dosimeters are irradiated to specified doses based on the instructions, specific machine calibration and dosimetric calculations.
You then irradiate the dosimeters to specified doses based on the instruction, specific machine calibration and your dosimetric calculations.

14. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How does it work?
The IAEA analyses the TLD dosimeters at their specialised laboratory in Austria, compares the dose determined from the TLD readings with the expected dose based on the machine’s calibration and dose calculation and provides the facility with a report on the accuracy of the machine dosimetry.
The IAEA analyses the TLD dosimeters at their specialised laboratory in Austria, compares the dose determined from the TLD readings with the expected dose based on the machine’s calibration and dose calculation and provides the facility with a report on the accuracy of the machine dosimetry.

15. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How does it work?
Here’s what a dosimetry audit report from the IAEA looks like.

16. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How does it work?
You can find more information about the IAEA’s Dosimetry Audit Programme on the IAEA website.
More details of the IAEA programme can be found at:

17. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
OBJECTIVES
To briefly review the reasons for participating in a dosimetry audit.
To outline how the IAEA programme works.
To examine the success of the IAEA Postal Dosimetry programme.
Next, we will examine the success of the IAEA Postal Dosimetry programme.

18. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
How many centres participate in this programme?
Since 1969 the IAEA Dosimetry Laboratory has provided dosimetry audits to 2,200 radiotherapy centres in 132 countries. This required 11,500 sets of TLDs.
So, how many centres participate in this program? Since 1969 the IAEA Dosimetry Laboratory has provided dosimetry audits to 2,200 radiotherapy centres in 132 countries. This required 11,500 sets of TLDs. As there are estimated to be about 8,000 radiotherapy centres worldwide, the IAEA programme reaches about one quarter.

19. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
And how many beams are checked?
As can be seen, interest in this programme has grown markedly over the last 25 years.
And how many beams are checked? As can be seen, interest in this program has grown markedly over the last 25 years.

20. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
Has the audit programme yielded real benefits?
The improvement in dosimetric quality over the years of operation of this programme has been remarkable.
The vital question is: Has the audit programme yielded real benefits? The improvement in dosimetric quality over the years of operation of this programme has been quite remarkable. The dashed line shows just how more accurate radiotherapy machine calibration has become over the years. The level of acceptable accuracy in calibration, defined as agreement between the institution’s estimate of dose and the IAEA’s TLD readings, is set at 5% in this programme. Unacceptable results from any beam result would be in a follow up to try to identify the cause of the problem. The solid line shows how this follow up action leads to yet further improvement.

21. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
Are there other postal dosimetry audit providers?
Are there other postal dosimetry audit providers?

22. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
Are there other postal dosimetry audit providers?
Yes, there are other postal dosimetry audit providers. We can see from this map that many of the dosimetry audit programmes collaborate with the IAEA to ensure consistency.
Country participating in the IAEA/WHO TLD service
National QA network or participant in international network other than IAEA
QA network co-operating with IAEA
Country not having radiotherapy or not participating in an audit network

23. Safety and Quality in Radiotherapy
MODULE 11: useful resources
Safety and Quality in Radiotherapy
Section 2: IAEA’s Postal Dosimetry Audit
summary
We have:
Briefly reviewed the reasons for participating in a dosimetry audit.
Outlined how the IAEA programme works.
Examined the success of the IAEA Postal Dosimetry programme.
And here’s a summary of this section. We have briefly reviewed the reasons for participating in an independent dosimetry audit, outlined how the one run by the IAEA works and explored its remarkable success.