Professional Documents
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A PALMER,
MSc, MIPEM,
J KEARTON,
MSc, MIPEM
and 1O HAYMAN,
MSc, MIPEM
Medical Physics Department, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK, and 2Chair of
the IPEM South East Central Interdepartmental Audit Group, UK
Objectives: The objective of this study was to determine current radiotherapy linear
accelerator quality control (QC) practice in the UK, as a comparative benchmark and
indicator of development needs, and to raise awareness of QC as a key performance
indicator.
Methods: All UK radiotherapy centres were invited to complete an online
questionnaire regarding their local QC processes, and submit their QC schedules. The
range of QC tests, frequency of measurements and acceptable tolerances in use across
the UK were analysed, and consensus and range statistics determined.
Results: 72% of the UKs 62 radiotherapy centres completed the questionnaire and
40% provided their QC schedules. 60 separate QC tests were identified from the
returned schedules. There was a large variation in the total time devoted to QC
between centres: interquartile range from 13 to 26 h per linear accelerator per month.
There has been a move from weekly to monthly testing of output calibration in the last
decade, with reliance on daily constancy testing equipment. 33% of centres thought
their schedules were in need of an update and only 30% used risk-assessment
approaches to determine local QC schedule content. Less than 30% of centres regularly
complete all planned QC tests each month, although 96% achieve over 80% of tests.
Conclusions: A comprehensive snapshot of linear accelerator QC testing practice in
the UK has been collated, which demonstrates reasonable agreement between centres
in their stated QC test frequencies. However, intelligent design of QC schedules and
management is necessary to ensure efficiency and appropriateness.
Received 15 December
2011
Revised 6 February 2012
Accepted 6 March 2012
DOI: 10.1259/bjr/46195110
2012 The Authors. Published by
the British Institute of Radiology
under the terms of the Creative
Commons Attribution-Non
Commercial License http://
creativecommons.org/licenses/bync/3.0/, which permits unrestricted
non-commercial reuse, provided
the original author and source are
credited.
Results
Of the 62 radiotherapy centres in the UK that were
contacted, 72% completed the online questionnaire and
40% submitted their QC schedules for analysis; the latter
comprised 62% with Varian Medical Systems (Palo Alto,
CA), 24% Elekta (Stockholm, Sweden), 5% Siemens
Medical Solutions (Forchheim, Germany) and 4% both
Varian and Elekta linear accelerators.
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Table 2. Proportion of centres routinely using indicated combinations of normal day, evening, weekend and early morning
sessions to undertake linear accelerator QC
Time linear accelerator QC is
undertaken
Early morning
Normal day
Evening
Weekend
Proportion of centres
30%
30%
12%
7%
7%
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
5%
5%
2%
2%
Y
Y
Y
Y
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Minimum value
First quartile
Mean
Third quartile
Maximum value
3.0
10.0
15.0
20.0
35.0
5.0
13.1
19.5
26.2
56.0
0.0
1.0
1.5
2.1
10.0
Table 4. Stated frequency of QC checks and percentage occurrence within submitted physics department QC schedules, for
checks identified in IPEM Report 81 [7], with comparison with previously recommended frequency
QC test
Included
IPEM Report in physics
QC
81
schedules
frequency
Daily Weekly
Daily
Daily
Daily
Daily
Daily
Weekly
Weekly
Weekly
Weekly
2-weekly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Monthly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
Quarterly
6-monthly
6-monthly
6-monthly
Annual
Annual
Annual
Annual
91%
83%
75%
64%
82%
20%
8%
13%
14%
12%
10%
10%
8%
10%
17%
48%
52%
52%
61%
48%
87%
44%
57%
65%
70%
30%
17%
9%
74%
43%
43%
57%
52%
83%
74%
43%
52%
23%
30%
65%
65%
52%
61%
26%
43%
35%
61%
78%
39%
35%
48%
9%
9%
9%
17%
7%
9%
35%
20%
23%
20%
6%
43%
0%
10%
10%
8%
8%
20%
Between
weekly
and
monthly
8%
9%
5%
20%
7%
13%
14%
12%
0%
60%
11%
6%
10%
Monthly
8%
8%
21%
0%
60%
40%
62%
53%
81%
29%
75%
100%
64%
50%
20%
77%
68%
89%
82%
30%
34%
50%
7%
20%
58%
43%
33%
30%
57%
22%
11%
Quarterly
or 6monthly Annual
8%
6%
25%
6%
10%
8%
8%
12%
20%
58%
33%
86%
80%
73%
8%
36%
67%
60%
88%
36%
61%
11%
12%
50%
6%
20%
16%
10%
8%
14%
13%
7%
33%
21%
10%
12%
7%
17%
78%
88%
100%
50%
3D, three-dimensional; IPEM, Institute of Physics and Engineering in Medicine; MLC, multileaf collimator; ODI, optical distance
indicator; PDD, percentage depth dose; QC, quality control.
Bold indicates the most common value, and hence the column that is recommended to the reader.
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QC test
Included in
physics QC
schedules
Per
patient
Daily
43%
22%
9%
9%
9%
39%
52%
13%
13%
13%
35%
26%
44%
44%
26%
30%
30%
30%
40%
10%
19%
10%
9%
100%
100%
22%
40%
50%
25%
Weekly
Between
weekly
and
monthly
Monthly
11%
20%
16%
10%
25%
50%
34%
17%
10%
10%
14%
20%
45%
40%
50%
50%
50%
44%
42%
66%
25%
66%
70%
50%
33%
29%
25%
20%
Quarterly
or 6monthly Annual
11%
11%
50%
44%
42%
100%
67%
50%
17%
20%
20%
67%
43%
25%
40%
12%
33%
25%
10%
14%
100%
20%
100%
100%
IMRT, intensity-modulated radiotherapy; IPEM, Institute of Physics and Engineering in Medicine; MLC, multileaf collimator; ODI,
optical distance indicator; QC, quality control.
Discussion
A 72% response rate to the online questionnaire gives
high significance to the results, being a good representation of UK practice. In most cases the respondent was
either the head of radiotherapy physics or the clinical
scientist responsible for QC, ensuring validity of the
responses.
A surprising number of radiotherapy centres reported
that they were aware their QC schedules were in need of
an update and suspected that efficiency or productivity
could be improved. It is possible this is a result of
Table 6. Modal value and range of stated tolerance or action value for selected QC checks, where sufficient responses were
provided for significance (n.5)
QC test
Modal tolerance
1.0%
1.5%
1.0 mm
1.0 mm
1.0 mm
1.0%
0.2u
0.5 mm
1.0 mm
1.0 mm
1.0 mm
2.0%
1.0%
3.0 mm
2.0%
1.5%
2.0 mm
1.0 mm
2.0 mm
1.0%
1.0u
2.0 mm
2.0 mm
2.0 mm
1.0 mm
5.0%
1.0%
5.0 mm
5.0%
3.0%
2.0 mm
2.0 mm
5.0 mm
2.0%
1.0u
2.0 mm
5.0 mm
2.0 mm
2.0 mm
5.0%
2.0%
5.0 mm
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Conclusion
A benchmark data set of linear accelerator QC testing
frequency and tolerance values has been presented that
is representative of practice across the UK, and shows a
high level of consistency between centres. There is
The British Journal of Radiology, November 2012
Acknowledgments
The authors wish to thank and acknowledge the
contribution of all centres that provided information to
this study. We also thank Stuart Williams and Colin Lee for
their assistance in data analysis, and gratefully acknowledge Matthew Hayman, of Innovation with Substance, for
implementation of the online questionnaire.
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