IMRT treatments in Belgium: IMRT treatments in Belgium: an update - - PowerPoint PPT Presentation

ICARO Vienna, 2009

• S. Vynckier

IMRT treatments in Belgium: IMRT treatments in Belgium: an update an update

S.

• S. Vy

Vyn nckier ckier

Stefaan.vynckier@uclouvain.be

U.C.L.- Cliniques universitaires Saint-Luc- Service de radiothérapie oncologique- Brussels, Belgium

ICARO Vienna, 2009

• S. Vynckier

±11 million habitants 25 radiotherapy centres 79 linear accelerators (including 7 Tomotherapy units) → about or less than 4 linacs / centre → between 500 and 2000 new patients per centre

ICARO Vienna, 2009

• S. Vynckier

Questionnaire

14+1 = 15 positive replies for IMRT treatments per 25 centers in Belgium

• +/- 60% of

IMRT treating centers

ICARO Vienna, 2009

• S. Vynckier

5 10 15 20 25 30 35 40 45 50 %

• f IMR

T treatm ents 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 centre num ber

%

• f IMRT treatm

ents per yearly num ber of total new treatm ents (curative & palliative)

total

?

ICARO Vienna, 2009

• S. Vynckier

5 10 15 20 25 30 35 40 45 50

% of IM RT treatm ents

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

centre num ber

%

• f IMRT treatm

ent: treatm ent m ethods

• th

er D MLC SMLC Tom

• ?

SMLC: step & shoot IMRT DMLC: dynamic leaves IMRT Tomo: Tomotherapy Other: Imat, Vmat, Rapid Arc

ICARO Vienna, 2009

• S. Vynckier

5 10 15 20 25 30 35 40 45 50 %

• f IMR

T treatm ents 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 centre num ber

%

• f IMRT treatm

ents: pathologies

u n kn

• wn
• th

ers Gyn ae Breast Lu n g Brain Prostate H &N

?

• S. Vynckier

Real patient Delivered fluence Delivered dose Calculated fluence Patient model Calculated dose

Patient QA

?

Machine QA Commissioning Pre-treatment QA

QA of IMRT QA of IMRT

ICARO Vienna, 2009

• S. Vynckier

Centre Time for Linac QA Patient QA Time for IMRT audit Who performs per month 1 patient QA patient QA?

1 (Tomo and SMLC)

• ccasional

all ( only Tomo) 1.3h Yes

• med. phys.

2 (Tomo and DMLC) 18-20h random 1h Yes

• med. phys.

3 (SMLC) 4h per class sol. 4h Yes

• med. phys.

4 (Tomo) 10h all 1.5h Yes

• med. phys./dosimetrist

5 (Tomo) 10h all 1h No

• med. phys.

6 (Tomo and DMLC) 10h all 0.3h No

• med. phys.

7(DMLC and SMLC) 0.6h all 1h No

• med. phys.

8 (DMLC) 6h all 2h No

• med. phys.

9 (SMLC) 20h all 2h No

• med. phys.

10 (SMLC) 8h all 1.2h No

• med. phys.

11 (DMLC) 3.5h all 0.5h No

• med. phys./dosimetrist

12 (SMLC) 2h all 3h Yes

• med. phys.

13 (DMLC) 6.5h all 0.5h No

• med. phys.

14 (DMLC) none all 2.5h No

• med. phys./dosimetrist

15 (?)

Some supplementary information

ICARO Vienna, 2009

• S. Vynckier
• More than 50% of the Belgian centers are applying IMRT, some

since 1994-1995; 7 Tomotherapy units are installed, which increases the number of IMRT treatments for a centre.

• Time for Machine QA is very variable, except on the Tomotherapy

units: protocols applied? Equipment used?

• Except 2 centers with a large experience, all centers are performing

a patient specific QA for all patients. Needed?

• Only a few centers performed a IMRT specific audit, mostly on

Tomotherapy machines, based on the experience we initiated in 2005.

• In this respect:
• Reference dosimetry as a first step, specialized techniques (IMRT,

stereotactic…) as a second step. Acknowledgements : I like to thank all Belgian Medical Physicists who contributed by their reply to the questionnaire

Summary

Under the auspices of the Federal Agency for Nuclear Control