Quality audits of radiotherapy centres in Latin America: a pilot experience of the International Atomic Energy Agency.

BACKGROUND: In Latin America radiotherapy quality varies significantly among hospitals, where highly equipped academic centers coexist with others not meeting minimal requirements. In 2007, the International Atomic Energy Agency published guidelines for auditing radiotherapy centers, known as the "Quality Assurance Team for Radiation Oncology" (QUATRO) audits. The present report summarizes a pilot experience with QUATRO audits to 12 radiotherapy centres. METHODS: The findings from QUATRO audits conducted in 12 radiotherapy centres in Latin America between 2008 and 2013 were analysed. Events representing weaknesses or gaps in the process of radiotherapy were recorded. Relevant data for estimating human and technological needs of visited centres were processed. The main difficulties and strengths faced by institutions were also documented. RESULTS: All 12 radiotherapy centres were successfully audited following the QUATRO method. IAEA provided a dosimetry kit for quality control. Forty percent of audited institutions were immersed in a health system that did not recognize cancer as a public health priority problem. With few exceptions, local training programs for physicists and technologists were scarce and research was not an activity of interest among physicians. Centres were provided with sufficient staff to meet the local demand, both in the case of radiation oncologists, physicists and radiation therapists. Three centres lacking the minimum infrastructure were identified. Three institutions did not perform gynaecological brachytherapy, and one installation delivered around 900 teletherapy treatments annually without simulation, planning or dosimetry equipment for that purpose. Recommendations to centres were classified as related to personnel, infrastructure, processes and institutional organizational aspects. Many recommendations warned governments about the evident need for allocating more budgetary resources to radiotherapy. Most recommendations pointed out different aspects related to strengthen human resources training and technological support to the audited centres. Scheduled follow-up visits were also stressed. CONCLUSION: The QUATRO audits proved to be a valuable tool for identifying weaknesses in infrastructure, human resources and procedures in radiotherapy centres. Follow-up visits conducted by the IAEA or by regional or local organizations are necessary in order to evaluate outcomes and sustainability of implemented recommendations.

Radioterapia de intensidad modulada en el tratamiento de tumores en pediatría, primeros casos en Cuba / Intensity Modulated Radiotherapy in treatment of tumors in children: first cases in Cuba

INTRODUCCIÓN. La radioterapia de intensidad modulada (IMRT) constituye una técnica de alta precisión basada en la definición volumétrica tridimensional de la anatomía del tumor y de los órganos críticos o en riesgo. Con el objetivo de asegurar la posibilidad de aplicar la IMRT en Cuba, en casos seleccionados de tumores en niños y adolescentes, se instrumentó un proyecto de investigación cuyos resultados se documentan en este informe. MÉTODOS. Se realizaron las primeras irradiaciones con IMRT en niños y adolescentes cubanos, con edades entre 6 y 18 años. La técnica empleada es la basada en aperturas geométricas y optimización inversa. Las irradiaciones fueron realizadas con un acelerador lineal con fotones de 6 MV, con colimador multiláminas. Las dosis de radiaciones administradas variaron según el tipo de tumor, y de acuerdo con las normas de radioterapia y la presencia de órganos críticos. Todos los pacientes fueron evaluados semanalmente, con controles radiológicos mediante placas portales electrónicas. RESULTADOS. Los pacientes irradiados (5) tenían los tumores siguientes: linfoma no-Hodgking del seno maxilar (1), glioma del tallo cerebral (1), linfoma no-Hodgking abdominal (1), condrosarcoma mesenquimatoso parameníngeo (1) y hemangiopericitoma parameníngeo (1). Las dosis de irradiación recibidas variaron entre 24 y 62 Gy. Fueron empleados entre 5 y 8 campos, con variaciones entre 10 y 20 segmentos. CONCLUSIONES. Se realizaron en Cuba las primeras irradiaciones con IMRT en niños y adolescentes, y se debe continuar extendiendo su empleo en aquellos casos donde su utilidad sea mayor(AU)

INTRODUCTION. The intensity modulated radiotherapy (IMRT) is a high performance technique based on the three-dimensional volumetric definition of tumor anatomy and of critical organs or at risk. To assure the possibility to apply the IMRT in Cuba in selected cases of tumors in children and adolescents, authors designed a research project whose results are documented in present report. METHODS. The first irradiations with IMRT in Cuban children and adolescents aged between 6 -18 were carried out. The technique used is that based on the geometric openings and inverse optimization. Irradiations were applied using a linear accelerator with 6 MV photons, with multileaf collimator. Doses administered varied according to the type of tumor, the radiotherapy standards and the presence of critical organs. All patients were assessed weekly with radiologic controls using electronic portal plates. RESULTS. Irradiated patients (5) had the following tumors: non-Hodgkin lymphoma of maxillary sinus (1), brain stem glioma (1), non-Hodgkin abdominal lymphoma (1), parameningeal mesenchymatous chondrosarcoma (1) and parameningeal hemangiopericytoma (1). Doses of radiation applied varied between 24 and 62 Gy. Between 5 and 8 fields were used with variations among 10 and 20 segments. CONCLUSIONS. In Cuba the first irradiations with IMRT in children and adolescents and its use must to be spreading to those cases where its usefulness is greater(AU)

Radioterapia de intensidad modulada en el tratamiento de tumores en pediatría, primeros casos en Cuba / Intensity Modulated Radiotherapy in treatment of tumors in children: first cases in Cuba

INTRODUCCIÓN. La radioterapia de intensidad modulada (IMRT) constituye una técnica de alta precisión basada en la definición volumétrica tridimensional de la anatomía del tumor y de los órganos críticos o en riesgo. Con el objetivo de asegurar la posibilidad de aplicar la IMRT en Cuba, en casos seleccionados de tumores en niños y adolescentes, se instrumentó un proyecto de investigación cuyos resultados se documentan en este informe. MÉTODOS. Se realizaron las primeras irradiaciones con IMRT en niños y adolescentes cubanos, con edades entre 6 y 18 años. La técnica empleada es la basada en aperturas geométricas y optimización inversa. Las irradiaciones fueron realizadas con un acelerador lineal con fotones de 6 MV, con colimador multiláminas. Las dosis de radiaciones administradas variaron según el tipo de tumor, y de acuerdo con las normas de radioterapia y la presencia de órganos críticos. Todos los pacientes fueron evaluados semanalmente, con controles radiológicos mediante placas portales electrónicas. RESULTADOS. Los pacientes irradiados (5) tenían los tumores siguientes: linfoma no-Hodgking del seno maxilar (1), glioma del tallo cerebral (1), linfoma no-Hodgking abdominal (1), condrosarcoma mesenquimatoso parameníngeo (1) y hemangiopericitoma parameníngeo (1). Las dosis de irradiación recibidas variaron entre 24 y 62 Gy. Fueron empleados entre 5 y 8 campos, con variaciones entre 10 y 20 segmentos. CONCLUSIONES. Se realizaron en Cuba las primeras irradiaciones con IMRT en niños y adolescentes, y se debe continuar extendiendo su empleo en aquellos casos donde su utilidad sea mayor

INTRODUCTION. The intensity modulated radiotherapy (IMRT) is a high performance technique based on the three-dimensional volumetric definition of tumor anatomy and of critical organs or at risk. To assure the possibility to apply the IMRT in Cuba in selected cases of tumors in children and adolescents, authors designed a research project whose results are documented in present report. METHODS. The first irradiations with IMRT in Cuban children and adolescents aged between 6 -18 were carried out. The technique used is that based on the geometric openings and inverse optimization. Irradiations were applied using a linear accelerator with 6 MV photons, with multileaf collimator. Doses administered varied according to the type of tumor, the radiotherapy standards and the presence of critical organs. All patients were assessed weekly with radiologic controls using electronic portal plates. RESULTS. Irradiated patients (5) had the following tumors: non-Hodgkin lymphoma of maxillary sinus (1), brain stem glioma (1), non-Hodgkin abdominal lymphoma (1), parameningeal mesenchymatous chondrosarcoma (1) and parameningeal hemangiopericytoma (1). Doses of radiation applied varied between 24 and 62 Gy. Between 5 and 8 fields were used with variations among 10 and 20 segments. CONCLUSIONS. In Cuba the first irradiations with IMRT in children and adolescents and its use must to be spreading to those cases where its usefulness is greater