ACR–AAPM TECHNICAL STANDARD FOR THE PERFORMANCE OF HIGH-DOSE-RATE BRACHYTHERAPY PHYSICS

PREAMBLE

INTRODUCTION

II.

QUALITY MANAGEMENT

II.

QUALITY MANAGEMENT

Quality Management Team

II.

QUALITY MANAGEMENT

Resources

II.

QUALITY MANAGEMENT

Service Records

II.

QUALITY MANAGEMENT

Records of Devices and Tools

II.

QUALITY MANAGEMENT

Important Policies (as applicable)

II.

QUALITY MANAGEMENT

Reporting structure for issues

III.

QUALITY ASSURANCE

IV.

QUALITY CONTROL

IV.

QUALITY CONTROL

Acceptance Testing

IV.

QUALITY CONTROL

Equipment Performance Evaluation

IV.

QUALITY CONTROL

Continous Quality Control

QUALIFICATIONS AND RESPONSIBLITIES OF PERSONNEL

Qualified Medical Physicist

QUALIFICATIONS AND RESPONSIBLITIES OF PERSONNEL

Physician (if applicable)

QUALIFICATIONS AND RESPONSIBLITIES OF PERSONNEL

Medical Dosimetrist

QUALIFICATIONS AND RESPONSIBLITIES OF PERSONNEL

Radiation Therapist

VI.

TREATMENT CONSIDERATIONS

Treatment Planning and Imaging

VI.

TREATMENT CONSIDERATIONS

Delivery

VII.

RADIATION SAFETY

VIII.

QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION

ACKNOWLEDGEMENTS

Writing Committee – members represent their societies in the initial and final revision of this practice parameter

ACR
Schofield, Deborah L PhD, Chair
Gros, Sebastien PhD
Saeed, Hina MD
Sensoy, Levent PhD
Tarver, Russell B MS
Wells, Michelle C MS

AAPM
Bailey, Daniel PhD
Rivard, Mark J PhD
Rokni, Michelle MS

Committee on Practice Parameters and Technical Standards – Medical Physics

(ACR Committee responsible for sponsoring the draft through the process)

Keenan, Mary Ann DMP, Chair	Berns, Eric A PhD	Bevins, Nicholas PhD	Buckey, Courtney R PhD
Carver, Diana E PhD	Dieguez Gonzalez, Ana MS	Grice, Jared V DMP	Gros, Sebastien PhD
Mawlawi, Osama PhD	Pacella, Matthew A MS	Rubinstein, Ashley E PhD	Schofield, Deborah L PhD
Tarver, Russell B MS

Committee on Practice Parameters and Technical Standards

(ACR Committee responsible for sponsoring the draft through the process)

Caplin, Drew M MD, Chair

Amurao, Maxwell MBA, PhD, Chair, Commission on Medical Physics

Larson, David B MBA, MD, Chair, Commission on Quality and Safety

Comments Reconciliation Committee

Amurao, Maxwell MBA, PhD	Bailey, Daniel PhD	Caplin, Drew M MD	Gros, Sebastien PhD
Keenan, Mary Ann DMP	Larson, David B MBA, MD	Pacella, Matthew A MS	Rivard, Mark J PhD
Rokni, Michelle MS	Saeed, Hina MD	Schofield, Deborah L PhD	Sensoy, Levent PhD
Tarver, Russell B MS	Wells, Michelle C MS

REFERENCES

1. NathRRDepartment of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA., AndersonL LLL, MeliJ AJA, OlchA JAJ, StittJ AJA, WilliamsonJ FJF. Code of practice for brachytherapy physics: report of the AAPM Radiation Therapy Committee Task Group No. 56. American Association of Physicists in Medicine. Med Phys 24:1557-98, .
2. KuboH DHDDepartment of Radiation Oncology, University of California Davis Cancer Center, Sacramento 95817, USA., GlasgowG PGP, PethelT DTD, ThomadsenB RBR, WilliamsonJ FJF. High dose-rate brachytherapy treatment delivery: report of the AAPM Radiation Therapy Committee Task Group No. 59. Med Phys 25:375-403, .
3. KutcherG JGJDepartment of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021., CoiaLL, GillinMM, et al. Comprehensive QA for radiation oncology: report of AAPM Radiation Therapy Committee Task Group 40. Med Phys 21:581-618, .
4. Richardson SL, Buzurovic IM, Cohen GN, et al. AAPM medical physics practice guideline 13.a: HDR brachytherapy, part A. Journal of Applied Clinical Medical Physics. 24(3):e13829, 2023 Mar.
5. Amurao M, Gress DA, Keenan MA, Halvorsen PH, Nye JA, Mahesh M. Quality management, quality assurance, and quality control in medical physics. Journal of Applied Clinical Medical Physics. 24(3):e13885, 2023 Mar.
6. United States Nuclear Regulatory Commission. Medical use of by-product material: Title 10; CFR Part 35. Available at: http://www.nrc.gov/reading-rm/doc-collections/cfr/part035/full-text.html. .
7. United States Nuclear Regulatory Commission. Consolidated guidance about materials licenses: program-specific guidance about medical use licenses (NUREG-1556, Volume 9, Revision 2). Available at: http://www.nrc.gov/reading-rm/doc-collections/nuregs/staff/sr1556/v9/r2/.
8. ButlerWayne MWMSchiffler Cancer Center, Wheeling Hospital and Wheeling Jesuit University, Wheeling, WV 26003-6300, USA. wbutler@wheelinghospital.com, MerrickGregory SGS. Clinical practice and quality assurance challenges in modern brachytherapy sources and dosimetry. Int J Radiat Oncol Biol Phys 71:S142-6, .
9. WilliamsonJeffrey FJFDepartment of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23298, USA. jwilliamson@mcvh-vcu.edu, DunscombePeter BPB, SharpeMichael BMB, ThomadsenBruce RBR, PurdyJames AJA, DeyeJames AJA. Quality assurance needs for modern image-based radiotherapy: recommendations from 2007 interorganizational symposium on "quality assurance of radiation therapy: challenges of advanced technology". Int J Radiat Oncol Biol Phys 71:S2-12, .
10. RivardMark JMJDepartment of Radiation Oncology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA., CourseyBert MBM, DeWerdLarry ALA, et al. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations. Med Phys 31:633-74, .
11. HackettSara LSLUniversity Medical Centre Utrecht. S.S.Hackett@umcutrecht.nl., DavisBenjaminB, NixonAndrewA, WyattRuthR. Constancy checks of well-type ionization chambers with external-beam radiation units. J Appl Clin Med Phys 16:508-514, .
12. HalvorsenPer HPHDepartment of Radiation Oncology, Middlesex Hospital, Middletown, Connecticut 06457, USA. per@halvorsen.name, DasIndra JIJ, FraserMartinM, et al. AAPM Task Group 103 report on peer review in clinical radiation oncology physics. J Appl Clin Med Phys 6:50-64, .
13. Halvorsen PP, Baydush AA, Buckey CC, et al. AAPM Medical physics practice guideline 15.A: Peer review in clinical physics. J Appl Clin Med Phys 24:e14151, .
14. American Association of Physicists in Medicine. AAPM Task Group 270 - Display Quality Assurance. Available at: https://www.aapm.org/pubs/reports/RPT_270.pdf. .
15. NathRRDepartment of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA., AndersonL LLL, LuxtonGG, WeaverK AKA, WilliamsonJ FJF, MeigooniA SAS. Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys 22:209-34, .
16. BeaulieuLucLDépartement de Radio-Oncologie, Centre hospitalier universitaire de Québec, Québec, Québec G1R 2J6, Canada. beaulieu@phy.ulaval.ca, Carlsson TedgrenAsaA, CarrierJean-FrancoisJF, et al. Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: current status and recommendations for clinical implementation. Med Phys 39:6208-36, .
17. Afsharpour H, Landry G, Reniers B, Pignol JP, Beaulieu L, Verhaegen F. Tissue modeling schemes in low energy breast brachytherapy. Physics in Medicine & Biology. 56(22):7045-60, 2011 Nov 21.Phys Med Biol. 56(22):7045-60, 2011 Nov 21.
18. MikellJustin KJKDepartment of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., KloppAnn HAH, GonzalezGraciela M NGM, et al. Impact of heterogeneity-based dose calculation using a deterministic grid-based Boltzmann equation solver for intracavitary brachytherapy. Int J Radiat Oncol Biol Phys 83:e417-22, .
19. Beaulieu LL, Ballester FF, Granero DD, et al. AAPM WGDCAB Report 372: A joint AAPM, ESTRO, ABG, and ABS report on commissioning of model-based dose calculation algorithms in brachytherapy. Med Phys 50:e946-e960, .
20. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Real Time Ultrasound Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=118+&releaseId=2
21. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=131+&releaseId=2
22. American College of Radiology. ACR–AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Magnetic Resonance (MR) Imaging Equipment. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=57+&releaseId=2
23. RivardMark JMJDepartment of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. mrivard@tufts-nemc.org, ButlerWayne MWM, DeWerdLarry ALA, et al. Supplement to the 2004 update of the AAPM Task Group No. 43 Report. Med Phys 34:2187-205, .
24. International Atomic Energy Agency, . INTERNATIONAL ATOMIC ENERGY AGENCY, Dosimetry in Brachytherapy – An International Code of Practice for Secondary Standards Dosimetry Laboratories and Hospitals, Technical Reports Series No. 492, IAEA, Vienna (2023). Available at: https://www.iaea.org/publications/15202/dosimetry-in-brachytherapy-an-international-code-of-practice-for-secondary-standards-dosimetry-laboratories-and-hospitals.
25. DeWerdLarry ALADepartment of Medical Physics and Accredited Dosimetry Calibration Laboratory, University of Wisconsin, Madison, Wisconsin 53706, USA., IbbottGeoffrey SGS, MeigooniAli SAS, et al. A dosimetric uncertainty analysis for photon-emitting brachytherapy sources: report of AAPM Task Group No. 138 and GEC-ESTRO. Med Phys 38:782-801, .
26. FraassBBUniversity of Michigan Medical Center, Ann Arbor, USA. bfraass@umich.edu, DoppkeKK, HuntMM, et al. American Association of Physicists in Medicine Radiation Therapy Committee Task Group 53: quality assurance for clinical radiotherapy treatment planning. Med Phys 25:1773-829, .
27. American College of Radiology. ACR Practice Parameter for Continuing Medical Education. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=130+&releaseId=2
28. SeibertJ AnthonyJAUC Davis Health, Sacramento, CA, USA., BlatnicaAnthony PAPTufts Medical Center, Boston, MA, USA., ClementsJessica BJBSouthern California Permanente Medical Group, Los Angeles, CA, USA., et al. AAPM medical physics practice guideline 7.a.: Supervision of medical physicist assistants. J Appl Clin Med Phys 21:11-15, .
29. American College of Radiology. ACR–ABS–ASTRO Practice Parameter for the Performance of Radionuclide-Based High-Dose-Rate Brachytherapy. Available at https://gravitas.acr.org/PPTS/GetDocumentView?docId=81+&releaseId=2
30. Prisciandaro J, Zoberi JE, Cohen G, et al. AAPM task group report 303 endorsed by the ABS: MRI implementation in HDR brachytherapy-Considerations from simulation to treatment. [Review]. Medical Physics. 49(8):e983-e1023, 2022 Aug.
31. BallesterFacundoFDepartment of Atomic, Molecular and Nuclear Physics, University of Valencia, E-46100 Burjassot, Spain. fballest@uv.es, GraneroDomingoD, Perez-CalatayudJoseJ, VenselaarJack L MJL, RivardMark JMJ. Study of encapsulated 170Tm sources for their potential use in brachytherapy. Med Phys 37:1629-37, .
32. Haie-MederChristineCDepartment of Radiotherapy, Brachytherapy Unit, Institut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, France., PötterRichardR, Van LimbergenErikE, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 74:235-45, .
33. ViswanathanAkila NANDepartment of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA. abs@americanbrachytherapy.org., BeriwalSushilS, De Los SantosJennifer FJF, et al. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part II: high-dose-rate brachytherapy. Brachytherapy 11:47-52, .
34. WilliamsonJ FJFRadiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA., LiZZ. Monte Carlo aided dosimetry of the microselectron pulsed and high dose-rate 192Ir sources. Med Phys 22:809-19, .
35. YamadaYoshiyaYDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. yamadaj@mskcc.org, RogersLelandL, DemanesD JeffreyDJ, et al. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy 11:20-32, .
36. ShawWilliamWDepartment of Medical Physics (G68), University of the Free State, Nelson Mandela Drive, Park West, Bloemfontein 9300, South Africa. shaww@ufs.ac.za., RaeWilliam I DWI, AlberMarkus LML. Equivalence of Gyn GEC-ESTRO guidelines for image guided cervical brachytherapy with EUD-based dose prescription. Radiat Oncol 8:266, .
37. United States Nuclear Regulatory Commission. NRC Regulations Title 10, Code of Federal Regulations; Part 71 - Packaging and Transportation of Radioactive Material. Available at: https://www.nrc.gov/reading-rm/doc-collections/cfr/part071/index.html. https://www.nrc.gov/reading-rm/doc-collections/cfr/part071/index.html.