BSS appendix II.22. “Registrants and licensees, in addition to applying the relevant requirements for quality assurance specified elsewhere in the Standards, shall establish a comprehensive quality assurance programme for medical exposures with the participation of appropriate qualified experts in the relevant fields, such as radiophysics or radiopharmacy, taking into account the principles established by the WHO and the PAHO.”
Comprehensive set of standards for QA (mainly in manufacturing and service industry)
Adapted e.g. by ESTRO to the radiotherapy environment
European Society for Therapeutic Radiology and Oncology (ESTRO) Advisory Report to the Commission of the European Union for the 'Europe Against Cancer Programme'. Quality Assurance in radiotherapy. Radiother. Oncol. 35: 61-73; 1995.
Quick note aside: How to get ISO 9000 certified… implementation steps
“ A systematic and independent examination and evaluation to determine whether quality activities and results comply with planned arrangements and whether the arrangements are implemented effectively and are suitable to achieve the objectives.”
“ Quality assurance in radiotherapy.”, Radiother. Oncol., 1995
AAPM task group 40: Kutcher GJ, Coia L, Gillin M, Hanson W, Leibel S, Morton RJ, Palta J, Purdy J, Reinstein L, Svensson G, et al. Comprehensive QA for radiation oncology: report of AAPM therapy committee task group 40. Med Phys 1994;21:581-618.
AAPM task group 53: Fraas, B. et al. Quality assurance for clinical radiotherapy treatment planning. Med. Phys. 25: 1773-1829; 1997.
AAPM task group 56: Nath R.; Anderson L.; Meli J.; Olch A.; Stitt J. A.; Williamson J. Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No 56. Med. Phys. 24:1558-98; 1997.
ACPSEM Position Paper: Millar M, Cramb J, Das R, Ackerly T, Brown G, Webb D. ACPSEM Position Paper: Recommendations for the safe use of external beams and sealed brachytherapy sources in radiation oncology. Aust.Phys.Eng.Sci.Med. 1997; 20 (Supp): 1-35
Institute of Physical Sciences in Medicine. Commissioning and quality assurance of linear accelerators, IPSM report 54. York: IPSM; 1988.
International Standards Organisation. Quality management and quality assurance standards. ISO 9000 series.
PAN AMERICAN HEALTH ORGANIZATION, Publicación Cientifica No. 499, Control de Calidad en Radioterapia: Aspectos Clínicos y Físicos, PAHO, Washington, DC (1986).
WHO (World Health Organisation). Quality Assurance in radiotherapy. Geneva 1988.
A centre intends to improve treatment set-up. The measure patient positioning using port films on 20 patients e.g. of the prostate. The random variations are of the order of 8mm and the systematic error on average 9mm.
The systematic error could at least partially attributed to different couch sag in simulator and treatment unit. This is reflected in update of the procedures.
A repeat test shows that not only the systematic but also the random uncertainty have improved (the latter potentially because of heightened awareness). The smaller random variation allows to pick up other systematic errors…
In addition to this the positive experience leads to the same tests to be done for other treatment sites...