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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

EqualEstro,adosimetrylaboratorykeepingpacewith

modernizationinradiotherapy

A.VERES

EqualEstroLaboratory,VillejuifParis

The external audit of therapy beams :The external audit of therapy beams :

EqualEqual--Estro ExperienceEstro Experience

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

EQUALLaboratorybecomeEqualEstrosas in2004

AccreditedbytheAFSSAPSsince2004(externalradiotherapy)

AccreditedbytheCOFRACsince2009(TLDmethod)

EqualEstro

laboratory

currently

propose

dosimetry

audits

in

:

Conventionalexternalradiotherapy

Brachytherapy

IMRTandTomotherapy

ComingsoonforCyberknife,Microbeamsandprotons

Since2004

Until2004

EQUALprojectwasstartedduring1998 dedicatedtoQCinexternalradiotherapy

launchedbyESTROandIGRParis

supportedby

the

EC

AbriefhistoryofEqualAbriefhistoryofEqualEstroEstro

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

TheEqualTheEqualEstroLaboratoryEstroLaboratory

Location

IGR Villejuif,Paris

LaboratoryTeam

1secretary

3technicians

1physicist

Currentactivityofthelaboratory

Dosimetryauditsinradiotherapy

Mandatorycontrols(France)

Volunteerchecks

Clinicaltrials

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

External

audits

with

an

independent

dosimetry

laboratory

QualityAssuranceQualityAssurance

InternalQA bythestaffincharge,workinginthehospital

Theaccuracyrequirementsandthemedicalconsequencesneeda

dedicatedQAprogramme

Externalaudits

have

been

performed

by

our

laboratory

External

audits

have

been

performed

by

our

laboratory

formorethan15yearsforinternationalclinicaltrialsformorethan15yearsforinternationalclinicaltrials

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

MeasuringthedoseforexternalauditsMeasuringthedoseforexternalaudits TLDsTLDs

PCL3,Fimel France

TLD

=

Thermoluminescent

dosimetryTLD

=

Thermoluminescent

dosimetry

Linac underdosemeasurements TLDs (tubes,powder,chips) TLDreadingsystem

TheTLDtechniqueisoneofthemethodsemployedfordose

measurements

ThemethodissimilartothatemployedbytheIAEAThemethodissimilartothatemployedbytheIAEA

EqualEstrouseTLDs fortheauditoftheexternalbeamsaswellfor

brachytherapy

Conventionalradiotherap

y

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

100%90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

MeasuringthedoseforexternalauditsMeasuringthedoseforexternalaudits

Ciberknife

Protons

IMRTand

Tomotherapy

M

oderntechniq

uesofradiotherapy

TPS Film

Filmdosimetry

EasyCube phantom

CompareTPSdose

distributionwith

film

dosedistribution

Smallbeams(MLC)

Smallsize,

solid

TLDs

chips

EasyCube phantom

Filmdosimetry+TLDtubes

Filmdosimetry

Orsay Proton

Therapy

Center

TLDchips

Available

In

work

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

Themostrecentrepeatabilitytest,performedonSeptember2009, fortheDTL937powder

Laboratoryinternal

tests

repeatability

Asetof15TLDs areirradiatedandreadbyEqualEstrolaboratory

Thetestisrepeatedperiodicallyorasneeded

TheresultisconsideredasacceptablewhenStd.dev.iswithin1%

REPEATABILITY TEST - DTL937_NhR28

0,28%

0,42%0,47%

0,23%

0,40%

0,27%

0,53%

0,21%

0,64%

0,07%

0,62%

0,30% 0,26%

0,14%

0,27%

0,96%

-0,56%

0,14%

-0,44%-0,29%

-0,44%

0,84%

0,30%

-0,02%

-0,48%

-0,03%0,08%

-0,40%

0,25%

0,08%

0,00%

0,50%

1,00%

1,50%

2,00%

2,50%

3,00%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

TLD N

Standarddeviationforeachtube

-3,00%

-2,00%

-1,00%

0,00%

1,00%

2,00%

3,00%

Deviationtotheaverage

=0,46%

MetrologyMetrology

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

0,950

0,970

0,990

1,010

1,030

1,050

IAEA-1998

IAEA-1999

RPC-1999

PQR-Br-2000

IAEA-2000

EROPAQ-2001

ISS-2001

IAEA-2002

RPC-2002

IAEA-2003

NRPI-Cz-2003

IAEA-2004

IAEA-2005

RPC-2005

IAEA-2006

IAEA-2007

IAEA-2008

Participating Laboratory and date

PLDm/

EEDs

Cobalt 60 - Equal-Estro reference source

mean = 0.997

S.D.(1s) = 0.010

LaboratoryexternalauditsLaboratoryexternalaudits intercomparisonsintercomparisons

0,950

0,970

0,990

1,010

1,030

1,050

IAEA-1998

UHG-1999

IAEA-1999

UMEA-1999

RPC-1999

LPRI-1999

PTW

-1999

PQR-2000

IAEA-2000

LPRI-2000

ISS-2001

RPC-2001

UHG-2001

PQR-2002

IAEA-2002

NRPI-Cz-2003

NRPI-Cz-2003

IAEA-2003

IAEA-2004

IAEA-2005

IAEA-2006

IAEA-2007

Participating Laboratory

EEDm/PLDs

Cobalt 60 - Equal-Estro readings

average = 1.000

1 standart deviaton = 0.006

CoCo60

gamma

beams60

gamma

beams

Forthelasttenyears resultsofForthelasttenyears resultsofintercomparisonsintercomparisons withwith

referencecentresshow:referencecentresshow:

astandarduncertaintywithinastandarduncertaintywithin1%1%

OurreferencesourceistestedOurreferencesourceistested OurTLDreadingsystemistestedOurTLDreadingsystemistested

Dosimetersirradiatedinourlaboratory

andreadbyotherlaboratories

Dosimetersirradiatedinreferencelaboratories

andreadinourlaboratory

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

ReferenceBeamOutput

Depth

Dose

Data

BeamOutputVariation

WedgeTransmissionFactor

ExternalauditservicesExternalauditservices

HighEnergyPhotonBeams:exampleofcheckedparameters

BrachytherapysystemsBrachytherapysystems

Onepointofcheck

Irradiationsusing3symmetricpositionsof

applicators

ExternalradiotherapyExternalradiotherapy

HDRandPDRsystemsusingIr192sources

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

5% withinOPTIMALLEVEL > 5%to 7% withinTOLERANCELEVEL > 7%to 10% outsideTOLERANCELEVEL > 10% EMERGENCYLEVEL

ACCEPTABILITYCRITERIA:measureddose/stateddoseACCEPTABILITYCRITERIA:measureddose/stateddose

DEVIATION LEVELS ontheDm/Ds() 3% withinOPTIMALLEVEL > 3%to 5% withinTOLERANCELEVEL > 5%to 10% outsideTOLERANCELEVEL > 10% EMERGENCYLEVEL

OKOK

RecheckRecheck

Stop+RecheckStop+Recheck

HighEnergyPhotonBeamsHighEnergyPhotonBeams

HDRandPDRsystemsHDRandPDRsystems

OKOK

RecheckRecheck

Stop+RecheckStop+Recheck

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

externaldosimetryauditsbecamemandatoryinFrancesince2004

MandatorycontrolsinFranceMandatorycontrolsinFrance

supervisedbytheAFSSAPS

(the FrenchHealth Products Safety Agency) OurlaboratoryisinchargeofsuchcontrolsinFranceOurlaboratoryisinchargeofsuchcontrolsinFrance

externalradiotherapy

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

MandatoryMandatorycontrolscontrols (in(inFranceFrance))

since2004,theserious deviationshasdiminuend

Beams controlled in the frame of AFSSAPS regulation

Between October 2004 and September 2009

2

233

775

728

559

568

2 0 0

203-87%

730-94%

68

2-94%

501-90%

513-90%

20-9%

30-

4%

41-6%

50

-9%

46

-8%

10-4%

15-2

%

5-1%

8-1%

7-1%

0

100

200

300

400

500

600

700

800

900

2004 2005 2006 2007 2008 2009Year

Numberofbeams

TOTAL Beams

Validated for deviation < 5%

Rechecked for deviation between5 to 10%

Rechecked for deviation > 10%

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Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

1.5%

92%

6.5%

d 5%

5% < d 10%

d > 10%

ResultsformandatorycontrolsResultsformandatorycontrols

totalnumber

of

beams,

controlled

since

2004

:

2863

451872631Nr.ofbeams

>10%5%

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

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December 2 4, 2009

ResultsofdosimetryauditsinbrachytherapyResultsofdosimetryauditsinbrachytherapy

Thecontrols

were

performed

for

European

centres

CollaborationbetweentheBRAPHYQS groupandEQUAL

LaboratorysinceJanuary2002

Brachytherapy dosimetry controls

11

8

10 10

4

0 0

4-100%

9-90%

8-80%

8-100%

11-

100%

0

1-10%

2-20%

00 0 000

5

10

15

2005 2006 2007 2008 2009Year

Num

berofcontrols

TOTAL No of controls

Validated for deviations < 7%

Rechecked for deviations in the range of 7 to 10%

Rechecked for deviations > 10%

geometricreconstructiontestsareadditionallyproposed

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

CONCLUSIONSCONCLUSIONS

EqualEstroprovideanindependentandtrustworthyverification

ofdosedelivery

The

metrology

is

one

of

most

important

aspects

of

the

activity

in

EqualEstrolaboratory

TheTLDmethod,asemployedbyourlaboratory,hasprovedits

suitabilityinpractice

Ourlaboratoryisinterestedindevelopingnewdosecontrol

techniques

Theexternal

audits

allows

detecting

dosimetricerrors

Majordeviationsfordosedeliveryaredecreasing

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

THANKSTOALLTHOSEWHOWEREINVOLVEDTHANKSTOALLTHOSEWHOWEREINVOLVED

IN

THE

EQUAL

Project:

IN

THE

EQUAL

Project:

AndrAndreeDutreixDutreix

JeanJeanChavaudraChavaudra

HansHansSvenssonSvensson

AndrAndr BridierBridier

IvaldoIvaldo FerreiraFerreira

AmAmlieRoulieRou

THANKSTOALLTHOSEWHOCONTINUETOSUPPORTTHANKSTOALLTHOSEWHOCONTINUETOSUPPORT

EQUALEQUALESTROESTRO

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December 2 4, 2009

Advances and Challenges in Radiation Protection of PatientsInternational Conference onModernRadiotherapy:

Versailles, France

December 2 4, 2009

THANKYOUFORYOURATTENTIONTHANKYOUFORYOURATTENTION