Quality Assurance

The term Quality Assurance describes a program that is designed to control and maintain the
standard of quality set for that program. For radiation oncology a quality assurance program
essentially a set of policies and procedures to maintain the quality of patient care. 1

The goal of Quality Assurance (QA) in Brachytherapy is not different than in external beam
radiotherapy: to maximize the likelihood that each individual treatment is administered consistently,
accurately and safely relative to the personnel and equipment resources accepted as standard in the field.
Quality Assurance resources are finite and therefore should be carefully targeted and organized so as to cover
all of the critical steps in delivering a brachytherapy treatment.

Quality assurance in brachytherapy is necessary to ensure that the patient's treatment is delivered as
prescribed, with a dose to the target volume within ±5% of the prescribed dos, a minimal dose to health
tissues and a minimal radiation exposure to staff. 4

A comprehensive quality-assurance program specifically designed for brachytherapy procedures should be in
effect in all Radiation Oncology Departments with brachytherapy facilities. Such protocols should be in
compliance with the regulations of the Nuclear Regulatory Commission (NRC) and the state in which the
institution is located.

To achieve the goal of accurate but cost-effective brachytherapy treatment requires development of
a system that is well documented and adhered to by all involved. To develop an adequate treatment
delivery system, the critical endpoints of each treatment type must be clearly identified so that
those steps in the treatment delivery process where the chance of error is significant can be anticipated.

It is important to make sure that sources of the correct strength and type are accurately positioned
in the applicators, as determined from the simulation radiographs, for the interval of time needed to
administer the dose or other quantity prescribed by the physician. Also, the treatment must be
administered safely, so as not to exceed accepted exposure limits for the patient and staff
involved in the procedure.

The source quality control programme includes a number of different types of check. Some are carried
out on receipt of sources from the manufacturer and then subsequently at regular intervals. The quality
control program should be as simple as possible so that the tests may be performed with an economy of effort
in a minimum amount of time.