32. Quality assurance for new techniques of brachytherapy

In addition to classical HDR, PDR or LDR brachytherapy, new techniques such as transperineal radioactive implantations of the prostate via template guidance, or vascular brachytherapy for the prevention of restenosis, are becoming increasingly popular. At the same time they are introduced in a department, a quality assurance program must be implemented both to minimize the risks of treatment misadministrations and to prove respect to legal liability.The authors try to point out the necessary equipments and the particularities of Q.A. programs which must cover all the steps of the treatment. They consider successively prostate and vascular brachytherapy, making for each of them, a quick review of the most current techniques (including associated accessories and imaging devices), showing the particularities of adapted computerized treatment planning systems and the characteristics of radioactive sources usually used (photon sources for prostate such as 192 Ir for temporary implants and 125I and 103 Pd for permanent implants, 192 Ir or bêta sources for vessels). Particular detectors and methods to be employed to perform quality controls of equipments and sources, or in vivo measurements, are also presented. Lastly the guidelines and recommendations for “good practice and quality assurance” concerning these particular techniques and published by different international organizations, or which are in the process of development, are summarized. It will be noted that volume definitions, dose prescription and reporting, dose planning, dosimetry, staffing and responsabilities,etc, are or should be included in a complete quality assurance program