The Equipment : safety, commissioning, re commissioning calibration : Equipements : sûreté, recette, modification calibration A medical physicist point of view. Albert Lisbona Medical Physics Department CLCC Nantes Atlantique a lisbona@nantes.fnclcc.fr
CT Scanner SPECT-CT MRI PET-CT Radiotherapy Information System Network Treatment delivery Radiotherapy Treatment Planning System Medical Linear Accelerator
Acceptance and Commissioning Acceptance : to verify that the machine fulfills all the specifications given by the manufacturer and the ones agreed on as requirements for purchase. In addition to this the unit should fulfill ALL safety requirements as documented by national and international standards (e.g. IEC documents). Manufacturer representative and hospital representative Commissioning : to ensure that the unit is suitable for patient treatment within a certain department including preparation and verification of planning data. Hospital representative
Commissioning Commissioning of radiotherapy equipment is a very important and complex process. One needs to know all specs of the equipment AND have the appropriate tools in relation with the technical level of radiotherapy procedures for patient. Only qualified experts should perform the commissioning and certify that a treatment unit is fit for use on patients.
Commissioning Simple treatments, 3D Conformal Radiation Therapy treatments, Complex treatments : Intensity Modulated Radiation Therapy (which conforms the dose more closely to the shape of the tumor target) with image guidance (Image Guided Radiation Therapy) Stereotactic RadioSurgery Stereotactic Radiation Therapy Respiratory gated radiation therapy
3D CRT IMRT To increase target dose with sparing of healthy tissue. Use of adapted equipments : 3D dose calculation software (convolution superposition algorithms), Medical linear accelerator, MultiLeavesCollimator, Real time imaging devices. To increase target dose with sparing of healthy tissue by 3D CRT optimization. Same equipments + : Adapted software using doses volumes constraints (knowledge data bases) to realize optimization.
Commissioning Innovative machines such as : HiArt (Tomotherapy), Cyberknife (Accuray).
QA AAPM, IPEMB, SEFM, SFPM,. Quality assurance recommendations including commissioning well established concerning : Medical imaging devices (CT scanner, SPECT/PET CT, MRI) Medical Linear Accelerators Radiotherapy Treatment Planning System In some countries these recommendations have been turned into regulation. Innovative radiotherapy is growing faster than quality assurance recommendations.
Re commissioning When the machine is upgraded to full production standards : Software version upgrade, Hardware upgrade (e.g. micromlc, IGRT, stereotactic treatments, ) Partially when change or upgrade of the Radiotherapy Information System.
Conclusion Quality Assurance program in order to maintain : Physical performances of equipments, Reliability on radiotherapy procedures, Level of confidence throughout the radiotherapy team. To pay particular attention to new technologies and/or complex radiotherapy procedures especially vs staff leveling.
Some references. IEC IAEA IEC 60601 2 1 Ed.3.0 Medical electrical equipment Part 2 1: Particular requirements for the basic safety and essential performance of electron accelerators in the range 1 MeV to 50 MeV IEC 62083 Ed 2.0 Medical electrical equipment Requirements for the safety of radiotherapy treatment planning systems
Some references. IMRT SRS TPS M. Alber et al.., Guidelines for the Verification of IMRT ESTRO, Brussels, Belgium, 2008. G.A. Ezzell et al. IMRT commissioning : Multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119, Med. Phys. 36 (11) November 2009. M.C. Schell et al. Stereotactic Radiosurgery, Report of Task Group 42, 1995. IAEA TECDOC 1540 Specification and Acceptance Testing of Radiotherapy Treatment Planning Systems April 2007.