IMRT treatments in Belgium: IMRT treatments in Belgium: an update an update S. Vy Vyn nckier ckier S. 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
% of IMRT treatm ents per yearly num ber of total new treatm ents (curative & palliative) 50 45 40 35 30 % of IMR T 25 treatm ents total 20 15 10 5 ? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ICARO centre num ber Vienna, 2009 S. Vynckier
SMLC: step & shoot IMRT DMLC: dynamic leaves IMRT Tomo: Tomotherapy Other: Imat, Vmat, Rapid Arc % of IMRT treatm ent: treatm ent m ethods 50 45 40 35 30 oth er D MLC 25 % of IM RT treatm ents SMLC 20 Tom o 15 10 5 ? 0 ICARO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Vienna, 2009 S. Vynckier centre num ber
% of IMRT treatm ents: pathologies 50 45 40 35 u n kn own oth ers 30 % of IMR T Gyn ae 25 treatm ents Breast 20 Lu n g Brain 15 Prostate 10 H &N 5 ? 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ICARO Vienna, 2009 centre num ber S. Vynckier
QA of IMRT QA of IMRT Calculated Patient fluence model Commissioning Calculated dose ? Patient QA Machine QA Delivered dose Pre-treatment QA Delivered Real fluence patient S. Vynckier
Some supplementary information Time for Linac Centre QA Patient QA Time for IMRT audit Who performs per month 1 patient QA patient QA? 1 (Tomo and SMLC) occasional 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. ICARO 13 (DMLC) 6.5h all 0.5h No med. phys. Vienna, 2009 14 (DMLC) none all 2.5h No med. phys./dosimetrist S. Vynckier 15 (?)
Summary � 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: Under the auspices of the Federal Agency for Nuclear Control � Reference dosimetry as a first step, specialized techniques (IMRT, stereotactic…) as a second step. ICARO Vienna, 2009 Acknowledgements : I like to thank all Belgian Medical Physicists who S. Vynckier contributed by their reply to the questionnaire
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