Optimizing quality and safety of high dose-rate brachytherapy

Specific guidance for delivering high dose-rate (HDR) brachytherapy to improve quality and safety is offered in a new white paper from the American Society for Radiation Oncology (ASTRO).

The white paper was published in Practical Radiation Oncology (2014;4[2]:65-70), and it is available, along with an executive summary, at www.practicalradonc.org. It was commissioned as part of ASTRO's Target Safely campaign.

The white paper evaluates the current safety and practice guidance for HDR brachytherapy, makes recommendations for guidance applications to the delivery of HDR brachytherapy, suggests topics where additional guidance is needed, and examines the adequacy of general physics, quality assurance (QA), and clinical guidance currently available for the most common treatment sites with regard to patient safety.

The manuscript also addresses HDR brachytherapy procedures, the use of checklists and forms, the multidisciplinary treatment team, challenges to maintaining safe use of HDR brachytherapy, and key measures for avoiding catastrophic failure.

To ensure correct actions are followed for a specific brachytherapy procedure, the white paper recommends the use of a quality-management program, including checklists and forms to maintain quality and prevent errors.

Due to the multidisciplinary nature of HDR brachytherapy treatment, the modality requires coordination among several clinicians to treat the patient accurately and safely. The white paper details the roles and qualifications of those directly involved with radiation therapy decisions: the radiation oncologist, medical physicist, medical dosimetrist, radiation therapist, and surgeon.

“As the technology and use of HDR brachytherapy advances, it is imperative that clinical, physics, and quality assurance guidance be reviewed and updated, as necessary, to ensure quality and patient safety in the treatment delivery,” said Bruce R. Thomadsen, PhD, a professor in the Department of Medical Physics at the University of Wisconsin School of Medicine and Public Health in Madison. “This white paper affirms that HDR brachytherapy is a safe treatment option when current process guidance is followed and appropriate clinical decisions are made based on clinical guidance provided in white papers such as this.”

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