The absorbed dose delivered to the patient in brachytherapy is directly proportional to the source strength in terms of the reference air-kerma rate (RAKR). Verification of this quantity by the hospitals is widely recognized as an important part of a quality assurance program. An external audit was performed on behalf of the Secondary Standard Dosimetry Laboratory at the Swedish Radiation Protection Authority (SSI).
The aim was to investigate how accurately the source-strength in 192Ir brachytherapy is determined at Swedish hospitals. The SSI reference well-type ion chamber and calibrated equipment were used to measure the RAKR of an 192Ir source in each of the 14 Swedish afterloading units. Comparisons with values determined by vendors and hospitals were made. Agreement in values of RAKR as determined by SSI, hospitals and vendors were in all cases within the ±3% uncertainty (at a coverage factor of k=2), typically guaranteed by the vendors. The good agreement reflects the robustness and easy handling of well-type chambers designed for brachytherapy in use by all Swedish hospitals. The 192Ir calibration service planned at SSI will solve the hospitals current problem with recalibration of equipment. SSI can also advise hospitals to follow the IAEA recommendations for measurement techniques and maintenance of equipment.
It is worthwhile for the hospitals to establish their own ratio (or deviation) with the vendor and follow it as function of time. Such a mean-ratio embeds systematic differences of various origins and have a lower uncertainty than has the RAKR alone, making it useful for early detection of problems with equipment or routines. SSI could also define requirements for the agreement between source strengths as determined by hospitals and vendors and couple this to an action plan, dependent on level of disagreement, and some kind of reporting to SSI.