Radiotherapy Dosimetry Audits in Taiwan Hospitals

Abstract Purpose: This study examines the practice of the regulation of Standards for Medical Exposure Quality Assurance (SMEQA) in Taiwan based on on-site quality audit for radiation therapy systems from 2016 to 2019. Methods and Materials: about 81 radiation therapy departments, 141 medical linear accelerators, 9 gamma knifes, 34 high dose rate brachytherapy systems, 20 Tomotherapys and 6 Cyberknives were audited yearly. The inspection was implemented in two stages. Data collection and analysis for each institute’s documents including QA operating procedure, ion chamber and electrometer calibration reports, and a questionnaire relating to machine type and staffing, were requested first and reviewed by specially trained auditors. On-site measurements of SMEQA core items, including beam output, beam profile and energy constancy for external beam therapy systems, and the source strength, positioning and timer accuracy for brachytherapy systems were audited second. More than 300 photon beams were measured from linacs, Gamma knives, Cyberknives and Tomotherapys, and more than 400 electron beams from linacs each year.Results: The radiation treatment resource is about 8.9 therapy machines or 7.5 MV/MeV/ion beam therapy machines per million population, respectively, and there are on average about 1.20 medical physicists per radiation therapy unit in Taiwan. There were more than 78% and 75% of photon and electron beams respectively from linacs with deviations measured to the stated reference-point dose within 1.0%. Photon beams have lower beam quality measurement deviations than electron beams, and more than 90% of photon beams from linacs were within 1.0%. Including in-plane and cross-plane measurements, more than 90% and 85% of photon and electron beams respectively with flatness consistency within 1.0%. Beam symmetry as an absolute value has more than 75% of measurements within 1.0%. All audit measurements in this study were within the SMEQA acceptance criteria.Conclusions: On-site machine QA audits have been implemented from 2016 to 2019 for all radiation therapy units each year. The measurement results have shown a high quality machine performance in Taiwan.