1. INTRODUCTION ................................................. 1
1.1. Cilobal cancer burden and the need for radiotherapy ..... 1
2. PROGRAMME DESKjN AND IMPLEMENTATION FLOW ..................... 6
2.1. Programme design ........................................ 6
2.1.1. Assessment of national needs and contrywide
distribution of radiotherapy facilities .......... 6
2.1.2. Assessment of institution's clinical needs ....... 7
2.1.3. Basic clinical essentials ........................ 7
2.1.4. Assessment of institution's infrastructure and
resources ........................................ 8
2.1.5. Formulation of radiotherapy programmes .......... 11
2.2. Programme implementation ............................... 13
2.2.1. Staff training .................................. 13
2.2.2. Equipment specification ......................... 13
2.2.3. Planning and construction of facilities ......... 14
2.2.4. Delivery of equipment ........................... 15
2.2.5. Planning and initiation of treatment ............ 16
2.3. Follow-up and assessment mission ....................... 17
3. STAFF REOUIREMENTS FOR A RADIATION THERAPY
PROGRAMME ................................................... 17
3.1. Hospital administrators ................................ 17
3.2. Radiotherapy staffing .................................. 18
3.2.1. Patient throughput assessment ................... 18
3.2.2. Staff ........................................... 19
3.3. Internal staff organization ............................ 30
3.3.1. Combined assessment clinic ...................... 30
3.3.2. Radiation safety ................................ 31
4. RADIOTHERAPY FACILITY DESIGN ................................ 32
4.1. External beam therapy .................................. 32
4.1.1. Examination rooms ............................... 33
4.1.2. Simulator room .................................. 33
4.1.3. Treatment planning room ......................... 33
4.1.1. Mould room ...................................... 34
4.1.5. Treatment room .................................. 34
4.1.6. Waiting areas ................................... 35
4.2. Low dose rate brachytherapy ............................ 35
4.2.1. Souree storage and preparation room ............. 36
4.2.2. Operating theatre ............................... 36
4.2.3. Treatment planning room ......................... 36
4.2.4. Patient rooms ................................... 37
4.2.5. Additional requirements for LDR remote
afterloading .................................... 37
4.3. High dose rate brachytherapy ........................... 37
4.3.1. Options ......................................... 38
4.3.2. Operating theatre/treatment room ................ 39
4.3.3. Treatment planning room ......................... 39
5. EQUIPMENT ................................................... 40
5.1. Introduction ........................................... 40
5.2. Equipment lor external beam radiotherapy ............... 40
5.2.1. Simulator and computed tomography simulators .... 41
5.2.2. Treatment planning equipment .................... 41
5.2.3. Teletherapy unit ................................ 41
5.2.4. Ouality assurance equipment ..................... 42
5.2.5. Radiation safety equipment ...................... 42
5.3. Equipment for brachytherapy ............................ 42
5.3.1. Imaging equipment ............................... 42
5.3.2. Equipment for treatment planning ................ 43
5.3.3. Treatment delivery equipment .................... 43
5.3.4. Ouality assurance equipment ..................... 45
5.3.5. Equipment for radiation safety and
source handling ................................. 45
6. QUALITY ASSURANCE OF THE RADIOTHERAPY PROGRAMME AND
RADIATION PROTECTION OF THE PATIENT ......................... 46
6.1. Clinical aspects of quality assurance programme ........ 48
6.1.1. Treatment policies .............................. 48
6.1.2. Clinical case conferences for review of
proposed/recent patient treatments .............. 48
6.1.3. Clinical follow-up and statistical review ....... 48
6.1.1. Physical aspects of the quality assurance
programme ....................................... 49
6.3. Radiotherapy planning and delivery ..................... 50
6.3.1. Initial evaluation .............................. 50
6.3.2. Therapeutic decisions ........................... 51
6.3.3. External beam radiotherapy ...................... 51
6.3.4. Brachytherapy ................................... 53
6.4. Maintenance programme .................................. 55
6.4.1. Preventive maintenance .......................... 56
6.4.2. Repairs ......................................... 56
6.4.3. Spare parts ..................................... 56
6.5. Investigation of accidental medical exposures .......... 57
6.6. Quality audits ......................................... 57
7. RADIATION PROTECTION AND SAFETY OF SOURCES .................. 58
7.1. Authorization .......................................... 58
7.2. Organization and managerial measures ................... 59
7.2.1. Management policy ............................... 59
7.2.2. Organization and responsibilities ............... 59
7.2.3. Staffing and training ........................... 61
7.2.4. Reassessment of training needs .................. 62
7.3. Safety in equipment and sources ........................ 62
7.4. Facility layout, shielding and interlocks .............. 63
7.4.1. External beams .................................. 63
7.4.2. Brachytherapy ................................... 65
7.5. Occupational protection ................................ 66
7.5.1. Investigation levels for staff exposures
in radiotherapy ................................. 67
7.5.2. Pregnant workers ................................ 67
7.5.3. Classification of areas ......................... 68
7.5.4. Individual monitoring and exposure assessment ... 68
7.5.5. Monitoring of the workplace ..................... 71
7.5.6. Rules and supervision ........................... 71
7.5.7. Procedures for external beam therapy ............ 71
7.5.8. Procedures for brachytherapy .................... 72
7.5.9. Supervision ..................................... 74
7.5.10.Health surveillance ............................. 75
7.5.11.Records ......................................... 75
7.6. Protection against medical exposure .................... 76
7.6.1. Responsibilities ................................ 76
7.6.2. Justification ................................... 76
7.6.3. Optimization .................................... 77
7.6.4. Calibration ..................................... 77
7.6.5. Clinical dosimetry .............................. 78
7.6.6. Quality assurance for medical exposures ......... 79
7.6.7. Investigation of accidental medical exposures ... 79
7.7. Prevention of accidental medical exposures ............. 80
7.8. Public exposures ....................................... 81
7.9. Safety during the transport of radioactive materials ... 81
7.10.Emergency plans ........................................ 82
7.10.1.Lost sources .................................... 82
7.10.2.Stuck sources ................................... 82
7.10.3.Contamination ................................... 82
7.10.4.Accidental exposures of patients ................ 83
APPENDIX I: RESPONSIBILITIES OF RADIATION ONCOLOGISTS
AND MEDICAL PHYSICISTS ......................................... 85
APPENDIX II: SPECIFICATIONS FOR TREATMENT SIMULATORS .......... 87
APPENDIX III: EQUIPMENT REQUIREMENTS FOR COMPUTERIZED
TREATMENT PLANNING SYSTEMS ..................................... 92
APPENDIX IV: SPECIFICATIONS FOR ORTHOVOLTAGE UNITS ............ 97
APPENDIX V: SPECIFICATIONS FOR 60Co TELETHERAPY UNITS
AND THEIR RADIATION SOURCES ................................... 102
APPENDIX VI: SPECIFICATIONS FOR LINEAR ACCELERATORS ......... 111
APPENDIX VII: FACTORS TO BE CONSIDERED WHEN CHOOSING
TELETHERAPY EQUIPMENT ......................................... 120
APPENDIX VIII: ADVANCED AND SPECIAL TECHNIQUES IN PHOTON
RADIOTHERAPY .................................................. 137
APPENDIX IX: BASIC EQUIPMENT RECOMMENDED FOR DOSIMETRY
IN EXTERNAL RADIATION THERAPY ................................. 145
APPENDIX X: COMPARISON OF HDR AND LDR BRACHYTHERAPIES ...... 148
APPENDIX XI: SPECIFICATION OF EQUIPMENT FOR REMOTE LDR
AND HDR AFTERLOADING BRACHYTHERAPIES .......................... 151
APPENDIX XII: SUMMARY OF ITEMS FOR REVIEWS OF RADIATION
PROTECTION AND SAFETY IN RADIOTHERAPY, INCLUDING LICENSING
AND INSPECTION REVIEWS ........................................ 157
APPENDIX XIII: CONSIDERATIONS FOR A QUALITY ASSURANCE
PROGRAMME IN RADIATION ONCOLOGY ............................... 166
APPENDIX XIV: CONSIDERATIONS FOR COMMISSIONING OF
RADIOTHERAPY EQUIPMENT ........................................ 189
APPENDIX XV: RADIATION SHIELDINCi FOR EXTERNAL BEAM
FACILITIES .................................................... 199
APPENDIX XVI: TRAINING REQUIREMENTS FOR RADIOTHERAPY .......... 211
ABBREVIATIONS ................................................. 217
REFERENCES .................................................... 219
IAEA PUBLICATIONS ON CLINICAL, MEDICAL PHYSICS, RADIATION
PROTECTION AND SAFETY ASPECTS OF RADIOTHERAPY ................. 225
CONTRIBUTORS TO DRAFTING AND REVIEW ........................... 227
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