ASTRO releases white paper to address SRS, SBRT safety

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As part of its Target Safely program, the American Society for Radiation Oncology (ASTRO) has published a white paper on the safe use of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) in the radiation oncology clinic, and published the executive summary of the report in the October print issue of Practical Radiation Oncology.

The SRS/SBRT paper is part of a series of white papers commissioned by ASTRO addressing patient safety and quality.

The white paper addressed the very high doses of radiation delivered by SRS and SBRT by outlining personnel considerations, technical considerations and acceptance testing and commissioning.

Timothy Solberg, PhD, lead author of the paper and professor of radiation oncology at the UT Southwestern Medical Center in Dallas, and colleagues recommended a team-based approach, with well-trained and credentialed specialists. They wrote that SRS and SBRT training should become a required part of both radiation oncology residency training and of Accreditation of Medical Physics Education Programs training.

"Patient safety in radiation therapy is everyone's responsibility," Solberg said in a statement. "Professional organizations, regulators, vendors and end-users must demonstrate a clear commitment to working closely together to ensure the highest levels of safety and efficacy in stereotactic radiosurgery and stereotactic body radiation therapy."

The authors also wrote that because various disease sites may have different clinical and technical requirements, clinics need to convene feasibility and planning discussions before undertaking new disease sites.

“SRS and SBRT require significant resources in personnel, specialized technology and implementation time,” wrote the authors. “A thorough feasibility analysis of resources required to achieve the clinical and technical goals must be performed and discussed with all personnel, including medical center administration.”

Treatment of SRS/SBRT patients should adhere to established national guidelines, according to the report. The development of acceptance and commissioning protocols and tests must be developed to ensure safe and effective operation.

The report pointed to ASTRO and American College of Radiology guidelines that call for strict protocols for quality assurance, and noted that these quality assurance programs must continually evolve to keep pace with technological advances. Processes also must  be developed for procedure checklists, documentation, reporting, peer review and continuous quality improvement.

As far as technical considerations are concerned, because SRS and SBRT use such high levels of radiation, technology standards should be higher than what is usually considered minimally acceptable for conformal radiotherapy and initial image-guided radiotherapy applications, according to the report. Comprehensive image guidance and motion management strategies must be applied and dose needs to be calculated through complex heterogeneities represented over the entire irradiated volume.

The full text of the white paper is available in advance of print online at