Quality Control of Brachytherapy Equipment in Kazakhstan: Current Stage and Minimum Requirements

Abstract

Objective: Brachytherapy is used in 17 radiotherapy facilities In Kazakhstan. Each institution has an individual quality control (QC) program in place to ensure the safe and accurate delivery of the treatment dose to the patient. The main objective of this paper is to explore current approaches to quality control of brachytherapy in Kazakhstan and reduce potential discrepancies in testing frequency and tolerance limits by identifying a set of basic quality control requirements. Materials and Methods: A detailed brachytherapy quality control questionnaire was provided to 17 radiotherapy institutions for completion. A separate questionnaire was sent to two institutions associated with brachytherapy. Questions addressed safety aspects, radiation parameters, total time spent on quality control, and available imaging systems for dose determination. The results of the survey were compared with the recommendations set found in international brachytherapy quality control documents. Results: The results of the questionnaires revealed significant differences in the frequency and methods of testing. For example, only two of the 17 centers have at least some kind of quality assurance program for brachytherapy treatment. Only five centers have equipment with the help of which dosimetric control can be performed, and only two centers have local medical physicists performing this control. One of the centers is checked quarterly, while the other is checked only once a year. In the remaining 15 centers, dosimetric control is performed by specialists who recharge the source without providing any document or protocol. There were also significant differences in the amount of time spent on quality control, mostly related to the variety of approaches to quality control and differences in the availability of resources. Almost all centers (15 of 17) rely only on inspections from the radionuclide source supplier and do not monitor the dosimetric and mechanical parameters of the facility at all. Conclusion: Based on the results of the survey and comparison with international recommendations, a set of basic requirements for brachytherapy quality control is needed.