Cancer Science & Therapy

A Survey on the Quality Assurance Procedures Used in Intensity Modulated Radiation Therapy (IMRT) at Indian Hospitals

Abstract

Rajesh Kumar, S.D. Sharma, H. I. Amols, Y.S. Mayya and H. S. Kushwaha

A national survey to obtain information about the Quality Assurance (QA) procedures and methods being followed at Indian radiotherapy centers for intensity modulated radiation therapy (IMRT) was conducted. A questionnaire containing parameters relevant to IMRT QA was evolved to collect the information pertaining to the QA of IMRT delivery system, QA of IMRT treatment planning system, and patient specific IMRT QA. The questionnaire was circulated to 40 hospitals in the country and responses of 31 centers were received. Survey results showed that 71% centers are having adequate machine specifi c IMRT QA programme, 19% centers have inadequate machine specific IMRT QA programme and 9% centers have irrelevant machine specific IMRT QA programme. No specific answer for question of QA tests of TPS specific to IMRT were received from the user. Almost all the centers have programme of setup verification of the patient by means of EPID/DRR/OBI. However, 91% of centers could not provide any information about the QA methodology of the devices used for setup verification. For patient specific dosimetric QA, almost all the hospitals have the program of pre-treatment dose verification using calibrated ionization chambers of sensitive volumes in the range of 0.01 to 0.65 cc. Dosimetric verification is performed by combining dose from all gantry angles to a single gantry angle. Two dimensional (2D) dosimetry systems such as radiographic and radiochromic films, 2D array of ionization chambers/ semiconductor diodes and EPID are also used in patient specific dosimetry verifications. Majority of the centers (about 48%) accept the plan with 3% dose difference and 3 mm dose to distance agreement criteria with gamma index less than unity. However, a number of other acceptance criteria specific to institution and tumor site are being also followed. This survey reveals that a variety of IMRT QA program is being followed at the Indian hospitals. This study has brought into focus the need to evolve a national protocol for IMRT QA so that treatment outcomes of all the IMRT centers of country can be compare