Is necessary a specific quality assurance guidance for current brachytherapy?

Abstract

Introduction. Brachytherapy has evolved from the traditional surgical paradigm to modern three-dimensional image-based planning and delivery approaches. Objectives. To analyse the international recommendations in brachytherapy quality assurance (QA) and the situation in Spain. Materials and methods. We have reviewed international recommendations and the Spanish reality regarding brachytherapy QA. In all international documents about brachytherapy QA there is a distinction between QA device (periodic testing of planning, delivery and imaging systems) and QA clinical process (patient-specific treatment procedures). Different proactive tools are used for a QA analysis, being the more used the failuremode and effect analysis (FMEA). It has three steps: first, generate an overview of the entire process (process map), in which all the nodes of the brachytherapy process are represented. Second, identify possible failure nodes in every part of the process. Third, develop process improvements lowering the overall risk for each failure node. The current Spanish RD1566/1998 (Quality Criteria in Radiotherapy), RD815/2001 (Justification of medical exposure to ionizing radiation) and Libro Blanco SEORXXI, deal with this subject. Results. Available brachytherapy QA international recommendations are relatively fixed protocols of specific tests, endpoints, tolerances and frequencies that have been developed by small panels of experts and reflect practice patterns that predate the image-based planning era. There is not unanimity in QA guidance. In our country there is no document/guide for brachytherapy QA. Spanish RD do not include specific recommendations. There are mandatory legal regulations for radiotherapy procedures in Spain with a punitive character. The Libro Blanco reflects the lack of studies and recommendations in brachytherapy QA. Conclusions. Due to the complexity and variability of image-based brachytherapy procedures, a risk-based guide including clear general QA protocols guidelines for the specific clinical implementations, is urgently needed.