Advanced

Quality Assurance in Radiotherapy - Development and evaluation of new tools for improved patient safety

Nordström, Fredrik LU (2012)
Abstract (Swedish)
Popular Abstract in Swedish

Strålbehandling är en av de vanligaste behandlingarna mot cancer. Hälften av alla behandlingar syftar till att bota patienten från sjukdomen, men strålbehandling är även en mycket effektiv behandling för att lindra smärta och andra symptom för patienter med en obotlig cancer.



Förberedelse inför strålbehandling är en komplicerad procedur, som innefattar många olika tekniska system och yrkeskategorier. Det är därför inte ovanligt att fel uppkommer i denna process. Världshälsoorganisationen (WHO) har rapporterat att risken för en enskild patient att drabbas av ett fel med milda till lindriga konsekvenser är ungefär 0.15%. Motsvarande risk för fel med allvarliga konsekvenser är... (More)
Popular Abstract in Swedish

Strålbehandling är en av de vanligaste behandlingarna mot cancer. Hälften av alla behandlingar syftar till att bota patienten från sjukdomen, men strålbehandling är även en mycket effektiv behandling för att lindra smärta och andra symptom för patienter med en obotlig cancer.



Förberedelse inför strålbehandling är en komplicerad procedur, som innefattar många olika tekniska system och yrkeskategorier. Det är därför inte ovanligt att fel uppkommer i denna process. Världshälsoorganisationen (WHO) har rapporterat att risken för en enskild patient att drabbas av ett fel med milda till lindriga konsekvenser är ungefär 0.15%. Motsvarande risk för fel med allvarliga konsekvenser är mellan 50 och 100 per miljon behandlingar.



Den snabba utvecklingen och introduktionen av ny teknik under det senaste decenniet har gjort det möjligt att ge behandlingar med hög noggrannhet. Detta medför att en hög stråldos kan ges till tumören, medan frisk vävnad skonas. De nya komplicerade teknikerna för planering och leverans av behandlingen kan även ha skapat en miljö med större sannolikhet för fel. Paradoxalt nog kan teknik för att öka noggrannheten även vara en ny källa till fel om den inte används korrekt.



För att reducera sannolikheten för fel är omfattande kvalitetssäkringssystem en del av strålterapiprocessen på moderna strålterapikliniker. Dessa system reducerar risken för olyckor och fel, samtidigt som de ökar sannolikheten att tidigt upptäcka de fel som ändå uppkommer och reducerar därmed konsekvenserna för patienten. Det finns dock en allmän oro att dagens kvalitetssäkringsprogram inte utgör ett adekvat och kostnadseffektivt skydd mot fel i behandlingar på grund av den snabba tekniska utvecklingen och introduktionen av nya behandlingstekniker.



Inom ramen för denna avhandling har nya effektiva verktyg utvecklats och utvärderats för att säkerställa att korrekta behandlingsparametrar används. En implementering av dessa verktyg, i det dagliga arbetet med att leverera högkvalitativa behandlingar, kan förbättra säkerheten för den enskilda patienten. (Less)
Abstract
Preparation for radiotherapy is a complex procedure that involves many different technologies and groups of professionals. The rapid development and introduction of new technologies throughout the last decade have made it possible to deliver highly conformal, individually-shaped dose distributions with high accuracy. However, there is widespread concern that current quality assurance practices have not been updated at the pace necessary to provide adequate and cost-effective safeguards against treatment delivery errors.



The overall aim of this thesis was to develop and evaluate new, efficient tools for patient-specific quality assurance of the radiotherapy process, including the following areas: transfer of information,... (More)
Preparation for radiotherapy is a complex procedure that involves many different technologies and groups of professionals. The rapid development and introduction of new technologies throughout the last decade have made it possible to deliver highly conformal, individually-shaped dose distributions with high accuracy. However, there is widespread concern that current quality assurance practices have not been updated at the pace necessary to provide adequate and cost-effective safeguards against treatment delivery errors.



The overall aim of this thesis was to develop and evaluate new, efficient tools for patient-specific quality assurance of the radiotherapy process, including the following areas: transfer of information, independent monitor unit verification, pre-treatment measurements, in vivo dosimetry, and end-to-end tests.



Within the framework of the thesis, a concept for ensuring data integrity was proposed and used to compare different combinations of treatment planning systems and record-and-verify systems with respect to data integrity. Because the concept is based on the Digital Imaging and Communications in Medicine (DICOM) global information standard, it is generally applicable to most radiotherapy computer systems. Additionally, a software for monitor unit verifications was developed, and the tools within Statistical Process Control were used to analyse calculation results from this software in a multicentre study. Time-resolved dosimetry systems were developed and applied to pre-treatment measurements and in vivo dosimetry, allowing rigorous analysis of the accuracy of the treatment planning and delivery systems and forming a basis for real-time in vivo dosimetry. Finally, gel dosimetry and anthropomorphic phantoms were demonstrated to provide important tools for complete end-to-end tests.



The tools developed in this thesis have two important applications: routine use in daily clinical practice, and when introducing new technologies in the local clinical setting. The proposed methods and concepts can improve patient safety and reduce the resources required for a comprehensive quality assurance program. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor McClean, Brendan, St. Luke’s Hospital, Dublin, Ireland
organization
publishing date
type
Thesis
publication status
published
subject
keywords
monitor unit verification, in vivo dosimetry, real-time verification, gel dosimetry, 4D dosimetry, IMRT, VMAT, data integrity, radiotherapy, Quality assurance
pages
52 pages
publisher
Lund University
defense location
Jubileumsaulan, Skåne University Hospital, Entrance 59, Malmö
defense date
2012-05-18 09:00
ISBN
978-91-7473-271-9
language
English
LU publication?
yes
id
f09f1b6c-8642-4843-a550-802a12368d7f (old id 2493127)
date added to LUP
2012-04-23 14:51:25
date last changed
2016-09-19 08:45:11
@phdthesis{f09f1b6c-8642-4843-a550-802a12368d7f,
  abstract     = {Preparation for radiotherapy is a complex procedure that involves many different technologies and groups of professionals. The rapid development and introduction of new technologies throughout the last decade have made it possible to deliver highly conformal, individually-shaped dose distributions with high accuracy. However, there is widespread concern that current quality assurance practices have not been updated at the pace necessary to provide adequate and cost-effective safeguards against treatment delivery errors.<br/><br>
<br/><br>
The overall aim of this thesis was to develop and evaluate new, efficient tools for patient-specific quality assurance of the radiotherapy process, including the following areas: transfer of information, independent monitor unit verification, pre-treatment measurements, in vivo dosimetry, and end-to-end tests.<br/><br>
<br/><br>
Within the framework of the thesis, a concept for ensuring data integrity was proposed and used to compare different combinations of treatment planning systems and record-and-verify systems with respect to data integrity. Because the concept is based on the Digital Imaging and Communications in Medicine (DICOM) global information standard, it is generally applicable to most radiotherapy computer systems. Additionally, a software for monitor unit verifications was developed, and the tools within Statistical Process Control were used to analyse calculation results from this software in a multicentre study. Time-resolved dosimetry systems were developed and applied to pre-treatment measurements and in vivo dosimetry, allowing rigorous analysis of the accuracy of the treatment planning and delivery systems and forming a basis for real-time in vivo dosimetry. Finally, gel dosimetry and anthropomorphic phantoms were demonstrated to provide important tools for complete end-to-end tests.<br/><br>
<br/><br>
The tools developed in this thesis have two important applications: routine use in daily clinical practice, and when introducing new technologies in the local clinical setting. The proposed methods and concepts can improve patient safety and reduce the resources required for a comprehensive quality assurance program.},
  author       = {Nordström, Fredrik},
  isbn         = {978-91-7473-271-9},
  keyword      = {monitor unit verification,in vivo dosimetry,real-time verification,gel dosimetry,4D dosimetry,IMRT,VMAT,data integrity,radiotherapy,Quality assurance},
  language     = {eng},
  pages        = {52},
  publisher    = {Lund University},
  school       = {Lund University},
  title        = {Quality Assurance in Radiotherapy - Development and evaluation of new tools for improved patient safety},
  year         = {2012},
}