Physics Pre-Conference Teaching Course

New quality management approaches in radiotherapy: the challenge to balance resources and quality for new technologies and techniques

Course Directors: N. Jornet (ES) and P. Nilsson (SE)

Course Aim:
In the last few years there has been an immense development of radiotherapy (RT ) equipment with advanced imaging and delivery techniques (IMRT , IGRT , IMAT ), and treatment planning systems with more complex image handling and dose calculation algorithms. The traditional approach to Quality Assurance [QA], based on guidelines with a list of tests and tolerance values for measured
parameters are still valid, but difficult to fulfil in practice due to the increase in complexity of the RT
chain.

There is an urgent need to broaden our view of QA so that we can balance patient safety and treatment quality versus available time and staff resources. Therefore, efforts should be made to refocus the QA approach by working in new directions, e.g. more process-oriented, and by learning how to use industry engineering quality management [QM] tools effectively to assess their potential in our field. As concluded in the AA PM symposium on “The Challenges of Advanced Technologies” held in Dallas in 2007 we require “a more flexible and process centred approach that would better balance catastrophic error mitigation and quality erosion, along with greater physician and vendor involvement”. It is also of major importance to set action thresholds in the controlled parameters according to the clinical impact that a variation exceeding the threshold would have, to define the sampling size for most of our tests, and to rationalise the periodicity of them. However, there’s still a paucity of published work on how to exploit industry engineering techniques in our field and on which is the best way to set action thresholds and periodicity. A reason could be that we are still not familiar with most of these tools. At the end of this course we would like you to be able to revise critically your QM programme to redefine tests, periodicity, sampling
sizes and action thresholds which would not only lead to a reduction of risk, but also result in a continuous
increase of the quality and safety of your treatments. This course will also cover some of the items in Quality and Risk management of the upcoming ESTRO -EFOMP core-curriculum for medical physicists in radiotherapy.

	Teaching Course Programme
08.30-08.45	Course presentation: N. Jornet (ES) , P Nilsson (SE)
08.45-09.15	QM paradigm: The challenges of new technology. Definitions: T. Knöös (SE)
09.15-09.45	QM in radiation oncology from a radiation oncologist's eye view: D. Zips (DE)
09.45-10.15	QM: What do we aim for? Considerations when setting tolerance and action limits  J. Olofsson (SE)
10.15-10.30	Coffee Break
10.30-11.30	Tools for developing a QM program:  Use of retrospective error analysis: E. Klein (USA)
11.30-12.30	Tools for developing a QM program: Proactive tools (including system engineering): B. Thomadsen (USA)
12.30-13.30	Lunch
13.30-13.55	The use of SPC to monitor process: K Herlevin Gérard (FR)
13.55-14.30	Balancing resources and quality: O. Holmberg (AT)
14.30-15.00	Roadmap of advances in QM in the States: B. Thomadsen (USA)
15.00-15.30	Towards patient specific QA. What can be done by equipment developers? Example  from a proton facility: S. König (CH)
15.30-16.00	Coffee Break
16.00-17.00	Ongoing initiatives in Europe: Group discussions  - Experience on the application of FMEA analyses for new techniques: M.Bijl (NL) - Statistical Control of the Spectral Quality of Electron Brams for Clinical Use:   Control Charts and Time Series: J.M. de la Vega Fernández (ES) -  Prospective approaches in modern RT: the Italian experience: Prof. M. Cantone (IT) - A Systems & Error Analysis method for Health Care: Enda Fallon (IE)
17.00-17.15	Closing remarks: P. Nilsson (SE)

Physics Pre-Conference Teaching Course

Advanced photon beam dose delivery systems and techniques

Course Director: B. Heijmen (NL)

Course aim
Until not so long ago, fixed-beam IMRT was considered by most as an advanced solution for shaping of photon beam dose distributions in complex cases. In the last years investigators have pointed at new treatment options, such as Tomotherapy, volumetric arc therapy (VMAT), non-coplanar robotic treatments, and tumor tracking. Improved conformality of the high dose volume to the tumor and/or reduced treatment times are often reported in the literature. Furthermore, claims have been made that with (future) treatment units with integrated MR-imaging, margins can be reduced to further enhance the therapeutic ratio. In this course, various on-going developments in in-room MR-imaging and novel dose delivery techniques will be discussed and compared in order to learn about their potential strengths and limitations, with an accent on quality of delivered dose distributions. Although this topic is strongly linked to technology, the aim of the course is to focus at clinical relevance. 

	Teaching course programme
09:00-09:30	Pitfalls and challenges in comparing dose distributions: C. Ceberg (SE)
09:30-10:00	Linac-MR integration – the UMC Utrecht approach: B. Raaymakers (NL)
10:00-10:30	Linac-MR integration – the University of Alberta Cross Cancer Institute approach: B.G. Fallone (CA)
10:30-11:00	Coffee Break
11:00-11:30	In-room MR-guidance - the Viewray system: S. Mutic (USA)
11:30-12:00	Integrated MR imaging for Simulation, Brachytherapy, and External Beam IGRT: D. Jaffray (CA)
12:00-12:45	VMAT-planning: principles, opportunities and limitations : M. Alber (DE)
12:45-13:45	Lunch
13:45-14:30	The trend towards rotational IMRT, evidence based or commercially driven? : A critical overview: T. Depuydt (BE)
14:30-15:00	On the importance of beam angle optimization and non-coplanar beam arrangements: B. Heijmen (NL)
15:00-15:30	Rotational IMRT delivery techniques: a critical comparison: S. Broggi (IT)
15:30-16:00	Coffee Break
16:00-16:30	Flattening Filter Free linacs - characteristics, pros and cons: T. Knöös (SE)
16:30-17:00	Tumor tracking in robotic spinal radiosurgery: C. Fürweger (DE)

RTT Pre-Conference Teaching Course

Clinical Management, Research and Development in radiotherapy for paediatric tumours 

Course Directors : M. Coffey (IE), A. Vaandering (BE) and F. Moura (PT)

Course Aim:
Focusing on best practice, this course will provide an update on the recent research and developments in
the management of paediatric cancer. Specifically designed for RTT s, RT nurses and other RO professionals, this course will give, an overview of the application of the most recent technology and optimum treatment protocols, which allow for maximum treatment benefits with minimum collateral effects in children undergoing radiotherapy as part of their oncologic treatment. Lectures will focus on the technical application, physical management and health-related quality of life. Specific treatment sites will also be outlined and discussed with the participants. The RTT role in paediatric research activities and projects will be presented. The meeting will conclude with a debate, in which, the participants are invited to contribute and share their own research experiences. Our long term aim is to promote and develop
an RTT research network across Europe with respect to the management of paediatric patients undergoing radiotherapy.

Course Directors :  M. Coffey (IE), A. Vaandering (BE) and F. Moura (PT)

	Teaching course programme
08:00-08:15	Welcome and introduction :  M. Coffey (IE)
08:15-10:00	State-of-the-art on Radiation Oncology
	The project in SIOP: R.D. Kortmann (DE)
	Brain Tumours / Medullablastoma / PNET: R. Taylor (GB)
	Sarcomas: F. Saran (GB)
10:00-10:30	Coffee Break
10:30-11:15	Overview of therapy concepts: K. Dieckmann (AT)
11:15-12:45	Treatment delivery and verification
	Tomotherapy: J. Dean (GB)
	Planning guidelines of paediatric craniospinal irradiation: F. Carruthers (BE)
12:45-13:00 13:00-14:00	Discussion Lunch
14:00-15:00	Multidisciplinary care / Monitoring and Management of side effects
	Multidisciplinary collaboration in paediatric malignancies: C. Jobe (GB) and L. Hume (GB)
	Acute toxicity profile of radiotherapy in 690 children and adolescents - RiSK data: N. Willich (DE)
15:00-16:00	Psychological Challenges of Paediatric Cancer and its Treatment for the Child and Family: A. Higgins (GB)
16:00-16:30	Overview on research and development on Radiotherapy
	Assessment of treatment plans and the delineation of target volumes and OAR for pediatric cases: I. Kristensen (SE)
16:30-17:00	Discussion
17:00	Conclusions