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Equal Esrto
Equal Esrto
A.VERES
EqualEstroLaboratory,VillejuifParis
InternationalConference onModernRadiotherapy:
AbriefhistoryofEqualEstro Until2004
EQUALprojectwasstartedduring1998
Since2004
EQUALLaboratorybecomeEqualEstrosas in2004 AccreditedbytheAFSSAPSsince2004(externalradiotherapy) AccreditedbytheCOFRACsince2009(TLDmethod) EqualEstrolaboratorycurrentlyproposedosimetryauditsin:
InternationalConference onModernRadiotherapy:
TheEqualEstroLaboratory Currentactivityofthelaboratory
Dosimetryauditsinradiotherapy
Mandatorycontrols(France) Volunteerchecks Clinicaltrials
Location
IGR Villejuif,Paris
LaboratoryTeam
1secretary 3technicians 1physicist
Versailles, France December 2 4, 2009
InternationalConference onModernRadiotherapy:
QualityAssurance
Theaccuracyrequirementsandthemedicalconsequencesneeda dedicatedQAprogramme
InternalQA bythestaffincharge,workinginthehospital
Externalaudits withanindependentdosimetrylaboratory
Externalauditshavebeenperformedbyourlaboratory formorethan15yearsforinternationalclinicaltrials
InternationalConference onModernRadiotherapy:
Measuringthedoseforexternalaudits TLDs
TLD=Thermoluminescentdosimetry
Conventionalradiotherapy
Linac underdosemeasurements
TLDs (tubes,powder,chips)
ThemethodissimilartothatemployedbytheIAEA
InternationalConference onModernRadiotherapy:
Measuringthedoseforexternalaudits
IMRTandTomotherapy
Filmdosimetry
Moderntechniquesofradiotherapy
Available
TPS
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Film
Smallbeams(MLC)
Smallsize,solidTLDs chips EasyCube phantom
TLDchips
Inwork
Ciberknife
Filmdosimetry+TLDtubes
Protons
Filmdosimetry Orsay ProtonTherapyCenter
Versailles, France December 2 4, 2009
InternationalConference onModernRadiotherapy:
Metrology
Laboratoryinternaltests repeatability
Asetof15TLDs areirradiatedandreadbyEqualEstrolaboratory
3,00%
3,00%
2,50%
= 0,46%
2,00%
2,00%
0,25%
0,96%
0,84% 0,30% 0,08% -0,44% -0,29% -0,44% -0,40% -0,02% -0,48% -0,03%
1,00%
1,50%
0,08% -0,56%
0,14%
0,00%
1,00%
-1,00%
0,64%
0,62%
0,50%
0,30% 0,27% 0,28%
0,42%
0,47% 0,23%
-2,00%
0,00% 0 1 2 3 4 5 6 7 8 9 10 11 12 13
-3,00% 15 16
14
TLD N
Themostrecentrepeatabilitytest,performedonSeptember2009, fortheDTL937powder
TheresultisconsideredasacceptablewhenStd.dev.iswithin1% Thetestisrepeatedperiodicallyorasneeded
Versailles, France December 2 4, 2009
InternationalConference onModernRadiotherapy:
Laboratoryexternalaudits intercomparisons
Co60gammabeams
Dosimetersirradiatedinourlaboratory andreadbyotherlaboratories
1,050
Dosimetersirradiatedinreferencelaboratories andreadinourlaboratory
1,050
EE Dm / PL Ds
mean = 0.997 S.D.(1s) = 0.010
PL Dm / EE Ds
1,010
1,010
0,990
0,990
0,970
0,970
0,950 IAEA - 1998 IAEA - 1999 IAEA - 2000 IAEA - 2002 IAEA - 2003 EROPAQ - 2001 PQR-Br - 2000 ISS - 2001 NRPI-Cz - 2003 RPC - 1999 RPC - 2002 RPC - 2005
PQR - 2000
LPRI - 1999
PTW - 1999
LPRI - 2000
Participating Laboratory
Ourreferencesourceistested
OurTLDreadingsystemistested
UHG - 2001
UHG - 1999
PQR - 2002
RPC - 1999
ISS - 2001
RPC - 2001
InternationalConference onModernRadiotherapy:
Externalauditservices
Externalradiotherapy
HighEnergyPhotonBeams:exampleofcheckedparameters ReferenceBeamOutput
Onepointofcheck Irradiationsusing3symmetricpositionsof
applicators
InternationalConference onModernRadiotherapy:
ACCEPTABILITYCRITERIA:measureddose/stateddose
HighEnergyPhotonBeams
DEVIATIONLEVELSontheDm/Ds() 3% > 3%to 5% > 5%to 10% > 10% withinOPTIMALLEVEL withinTOLERANCELEVEL outsideTOLERANCELEVEL EMERGENCYLEVEL Recheck Stop+Recheck OK
HDRandPDRsystems
5% > 5%to 7% > 7%to 10% > 10% withinOPTIMALLEVEL withinTOLERANCELEVEL outsideTOLERANCELEVEL EMERGENCYLEVEL Recheck Stop+Recheck
Versailles, France December 2 4, 2009
OK
InternationalConference onModernRadiotherapy:
MandatorycontrolsinFrance
externaldosimetryauditsbecamemandatoryinFrancesince2004 externalradiotherapy
OurlaboratoryisinchargeofsuchcontrolsinFrance
InternationalConference onModernRadiotherapy:
Mandatorycontrols (inFrance)
Beams controlled in the frame of AFSSAPS regulation Between October 2004 and September 2009
900 775
TOTAL Beams
800
730 - 94%
501 - 90%
Number of beams
500
200
233
300
559
600
50 - 9%
20 - 9%
30 - 4%
10 - 4%
8 - 1%
2004
2005
2006
Year
2007
5 - 1%
2008
since2004,theserious deviationshasdiminuend
Versailles, France December 2 4, 2009
7 - 1%
100
15 - 2%
41 - 6%
568
Rechecked for deviation between 5 to 10% Rechecked for deviation > 10%
682 - 94%
728
InternationalConference onModernRadiotherapy:
Resultsformandatorycontrols
totalnumberofbeams,controlledsince2004:2863
Deviation() Nr.ofbeams 5% 2631 5%< 10% 187 >10% 45
InternationalConference onModernRadiotherapy:
Resultsofdosimetryauditsinbrachytherapy
ThecontrolswereperformedforEuropeancentres
15
11 - 1 0 0%
11
N u m b e r o f c o n tro ls
8 - 100%
8 - 80%
10
10
10
9 - 90 %
5
2 - 20%
1 - 10%
4 - 100%
2005
2006
Year
2007
2008
2009
0 0
InternationalConference onModernRadiotherapy:
CONCLUSIONS
EqualEstroprovideanindependentandtrustworthyverification ofdosedelivery Themetrologyisoneofmostimportantaspectsoftheactivityin EqualEstrolaboratory TheTLDmethod,asemployedbyourlaboratory,hasprovedits suitabilityinpractice Ourlaboratoryisinterestedindevelopingnewdosecontrol techniques Theexternalauditsallowsdetectingdosimetric errors Majordeviationsfordosedeliveryaredecreasing
InternationalConference onModernRadiotherapy:
THANKSTOALLTHOSEWHOWEREINVOLVED INTHEEQUALProject:
AndreDutreix JeanChavaudra HansSvensson Andr Bridier Ivaldo Ferreira AmlieRou
THANKSTOALLTHOSEWHOCONTINUETOSUPPORT
EQUALESTRO
Versailles, France December 2 4, 2009
InternationalConference onModernRadiotherapy:
THANKYOUFORYOURATTENTION