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- Enhancing quality and safety of advanced radiation therapy treatments in Croatia under the IAEA project CRO6019 - an overview

Introduction The International Atomic Energy Agency (IAEA), under the Technical Cooperation with member states, supports projects related to medical use of ionizing radiation. During three former IAEA TC cycles medical physics group committed to radiation oncology at the University Hospital (UH) Rijeka developed a comprehensive quality assurance programme in radiation oncology. Under the first project quality assurance/quality control (QA/QC) programmes between two hospitals (Rijeka and Osijek) were upgraded and harmonized, while the main objective of the second one was the extension of established good local QA/QC practices at the national level as well as putting the relevant requirements into the legislation. Under the third project preconditions for the clinical use of advanced radiotherapy techniques were specified and developed for implementation. Materials and methods Under the ongoing IAEA project “Verifying intensity modulated radiotherapy (IMRT) treatment dose delivery - method development, standardization and implementation throughout organization of a national audit” (CRO/6019, 2020- 2021), Medical Physics Department of the UH Rijeka are developing a robust methodology to quantify, evaluate and optimize IMRT dose delivery at the national level. In the first phase of the project, the QA/QC procedures required to evaluate, and optimize IMRT dose delivery were thought out, developed, prepared, and verified. The methodology was verified using a set of IMRT optimized dose distributions for the most common patient anatomies. Results After the analysis of IMRT dose delivery quality based on the two-dimensional array detector IBA Matrixx, software IBA OmniPro I'mRT, IBA MultiCube and CIRS 002LFC semi-anthropomorphic phantom, comprehensive QA/QC programme for the clinical use of advanced radiotherapy techniques was developed, improved and functional at University Hospital Rijeka. QA/QC protocols for verification of IMRT dose delivery were upgraded in accordance with developed methodology and QA manuals were upgraded accordingly. The methodology for verifying IMRT treatment dose delivery was upgraded and improved according to new equipment: Plan Verification System OCTAVIUS 4D which contains OCTAVIUS detector 1500 and motorized cylindrical phantom OCTAVIUS 4D. To reconstruct 3D absorbed dose distributions from measured data and to evaluate the dosimetric agreement between measured and calculated dose, we used a VeriSoft Patient Plan Verification software. Discussion In the second phase of the project, the methodology that has been developed in UH Rijeka will be generalized with the purpose of verifying IMRT dose delivery at Croatian radiation oncology departments where advanced treatment modalities are in clinical practice. After the analysis of the baseline situation, required steps will be taken to propose measures for adjustment of dose delivery protocols for IMRT planning and delivery at the national level. Conclusion The required conditions to attain the best possible quality of IMRT dose delivery with available equipment and technology will be fulfilled and a Croatian standard of good practice concerning advanced radiation therapy techniques will be established. Overall objective of this project is to enhance quality and safety of advanced radiation therapy treatments in Croatia.

IAEA, Technical Cooperation Project, QA/QC procedures, IMRT dose delivery

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