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Volume 1, Number 2, 1996

Quality assurance in radiation treatment planning. Princple considerations and a practical proposal

Ulf Rosenow


While detailed quality assurance based on standard protocols is mandatory in external beam radiotherapy for treatment machines, dosimetry, dose specification and recording, no standard protocols are known for radiation treatment planning. Users of treatment planning system have, to some extent, introduced their own system checks, but usually one relies on hand calculations to verify doses to reference points in a patient treatment plan. Also, there appears to be at present a wide-spread belief that the application of treatment planning systems in the daily routine will be sufficient to reveal any deficiencies the system might have. A few attempts have been made to introduce formalized quality control (QC) protocols for treatment planning (Rosenow et al, 1988; Rosenow et al, 1989), and specific investigations in this problems have been reported (Mc Cullough and Krueger, 1980; Rosenow and Burmester, 1978; Rosenow, 1977; Rosenow et al, 1984; Rosenow et al, 1987; AAPM, 1995). Obviously, there is an urgent need for standardized QC protocols in treatment planning systems. However, there exist fundamental obstacles to quality assurance in radiation treatment planning systems. Such systems can only reproduce accurately, i.e. within the tolerance of the system, the data directly entered into the system, e.g. measured beam dose distributions. Essentially all other calculations of dose distributions are estimates, or rather predictions, in terms of the real dose distribution in the patient or phantom, of what will results from a specific irradiation technique. Therefore, the goal for QC in treatment planning can only be to establish confidence in calculation results which are, in principle, not verifiable.

Signature: Rep Pract Oncol Radiother, 1996; 1(2) : 72-78

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