title: Dosimetric verification of radiotherapy treatment planning systems in Serbia: national audit.
abstract: BACKGROUND
  Independent external audits play an important role in quality assurance programme in radiation oncology. The audit supported by the IAEA in Serbia was designed to review the whole chain of activities in 3D conformal radiotherapy (3D-CRT) workflow, from patient data acquisition to treatment planning and dose delivery. The audit was based on the IAEA recommendations and focused on dosimetry part of the treatment planning and delivery processes.
  
  
  METHODS
  The audit was conducted in three radiotherapy departments of Serbia. An anthropomorphic phantom was scanned with a computed tomography unit (CT) and treatment plans for eight different test cases involving various beam configurations suggested by the IAEA were prepared on local treatment planning systems (TPSs). The phantom was irradiated following the treatment plans for these test cases and doses in specific points were measured with an ionization chamber. The differences between the measured and calculated doses were reported.
  
  
  RESULTS
  The measurements were conducted for different photon beam energies and TPS calculation algorithms. The deviation between the measured and calculated values for all test cases made with advanced algorithms were within the agreement criteria, while the larger deviations were observed for simpler algorithms. The number of measurements with results outside the agreement criteria increased with the increase of the beam energy and decreased with TPS calculation algorithm sophistication. Also, a few errors in the basic dosimetry data in TPS were detected and corrected.
  
  
  CONCLUSIONS
  The audit helped the users to better understand the operational features and limitations of their TPSs and resulted in increased confidence in dose calculation accuracy using TPSs. The audit results indicated the shortcomings of simpler algorithms for the test cases performed and, therefore the transition to more advanced algorithms is highly desirable.
authors.affiliation: Institute of oncology of Vojvodina, Sremska Kamenica, Serbia. lakiruki@gmail.com
authors.forename: Laza
authors.initials: L
authors.lastname: Rutonjski
authors.forename: Borislava
authors.initials: B
authors.lastname: Petrović
authors.forename: Milutin
authors.initials: M
authors.lastname: Baucal
authors.forename: Milan
authors.initials: M
authors.lastname: Teodorović
authors.forename: Ozren
authors.initials: O
authors.lastname: Cudić
authors.forename: Eduard
authors.initials: E
authors.lastname: Gershkevitsh
authors.forename: Joanna
authors.initials: J
authors.lastname: Izewska
mesh_terms: D000465:Algorithms; D002138:Calibration; D002277:Carcinoma / Q000532:radiotherapy; D054869:Clinical Audit; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D015337:Multicenter Studies as Topic; D019047:Phantoms, Imaging / Q000592:standards; D011785:Quality Assurance, Health Care; D011874:Radiometry / Q000379:methods / Q000592:standards; D011879:Radiotherapy Dosage / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D020266:Radiotherapy, Conformal / Q000379:methods / Q000592:standards; D055771:Serbia