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

2. 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

3. IAEA 3 Currently >90% results are within 5% acceptance limit 2012-2013: N = 1271, m = 1.005, SD = 0.068, 92% res. within 5% 1969-2013: N = 10226, m = 1.008, SD = 0.08, 83% res. within 5% limit ±5%

4. IAEA TLD results within the 5% limit 4

5. IAEA TLD results: use of CoPs (2000-2013) 126 deviations beyond 20% excluded TLD results 2000-2013 5

6. 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

7. 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

8. IAEA 8 Comprehensive RT audit: QUATRO

9. 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

10. 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 – 30 + 3 re- audits; Latin America – 13

11. 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

12. IAEA THANK YOU 12