Original paper| Volume 65, P6-14, September 2019

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A national survey on technology and quality assurance for stereotactic body radiation therapy

Published:August 05, 2019DOI:


      • The current status of SBRT technology and QA in Italy has been surveyed.
      • The most available delivery system for SBRT was linac with VMAT modality.
      • CBCT was the most used IGRT technique.
      • 40% of centers adopted respiratory motion management during treatment delivery.
      • This survey is a first step towards the harmonization in SBRT dosimetry and QA procedures.



      Stereotactic body radiation therapy (SBRT) for early stage solid tumors and metastases is increasing worldwide. In 2013, the Italian Association of Medical Physicists (AIFM) created a working group in order to standardize the SBRT dosimetric aspects (AIFM/SBRT-WG). The aim of this study was to investigate the current status of technology and quality assurance (QA) as regards SBRT in Italy. Clinical evaluation of SBRT was beyond the scope of the present study.


      A pre-questionnaire was designed by three medical physicists expert in SBRT. It contained questions on 4 main aspects: technology, image-guidance solutions (IGRT), treatment planning system commissioning and QA. In early 2018, all the centers involved in the AIFM/SBRT-WG were invited to complete the online questionnaire.


      The survey was undertaken by 45 centres (83% of them involved in the AIFM/SBRT-WG). The most available delivery system was conventional linacs with VMAT modality; 6MV and 6MV-FFF were the most common energies; robotic couch was available in 56% of centers; CBCT/MVCT was the most used IGRT technique (58% of centers) and 40% of centers adopted respiratory management during treatment delivery. The smallest measured field size for lateral beam profiles was ≤1 × 1 cm2 in 79% of linac-based centers. Great heterogeneity in terms of protocols and guidelines for QA were found. A large number of centers (51%) felt the need to upgrade their dosimetric QA devices dedicated to SBRT.


      This survey on SBRT is a starting point in standardizing the dosimetry of SBRT verification and to improve the QA procedure.


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        • Timmerman R.D.
        • Paulus R.
        • Pass H.I.
        • Gore E.M.
        • Edelman M.J.
        • Galvin J.
        • et al.
        Stereotactic body radiation therapy for operable early-stage lung cancer: findings from the NRG oncology RTOG 0618 trial.
        JAMA Oncol. 2018; 4: 1263-1266
        • Joo J.H.
        • Park J.H.
        • Kim J.C.
        • Yu C.S.
        • Lim S.B.
        • Park I.J.
        • et al.
        Local control outcomes using stereotactic body radiation therapy for liver metastases from colorectal cancer.
        Int J Radiat Oncol Biol Phys. 2017; 99: 876-883
        • Mancosu P.
        • Clemente S.
        • Landoni V.
        • Ruggieri R.
        • Alongi F.
        • Scorsetti M.
        • et al.
        SBRT for prostate cancer: challenges and features from a physicist prospective.
        Phys Med. 2016; 32: 479-484 Review
        • Mancosu P.
        • Nisbet A.
        • Jornet N.
        Editorial: the role of medical physics in lung SBRT.
        Phys Med. 2018; 45: 205-206
        • Palma D.A.
        • Olson R.
        • Harrow S.
        • Gaede S.
        • Louie A.V.
        • Haasbeek C.
        • et al.
        Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-COMET): a randomised, phase 2, open-label trial.
        Lancet. 2019; 393: 2051-2058
        • Benedict S.H.
        • Yenice K.M.
        • Followill D.
        • Galvin J.M.
        • Hinson W.
        • Kavanagh B.
        • et al.
        Stereotactic body radiation therapy: the report of AAPM task group 101.
        Med Phys. 2010; 37: 4078-4101
        • Dahele M.
        • Hatton M.
        • Stotman B.
        • Guckenberger M.
        Stereotactic body radiotherapy: a survey of contemporary practice in six selected European countries.
        Acta Oncol. 2015; 54: 1237-1241
        • Aznar M.C.
        • Warren S.
        • Hoogeman M.
        • Josipovic M.
        The impact of technology on the changing practice of lung SBRT.
        Phys Med. 2018; S1120–1797: 30659-30662
        • Villaggi E.
        • Hernandez V.
        • Fusella M.
        • et al.
        Plan quality improvement by DVH sharing and planner’s experience: results of a SBRT multicentric planning study on prostate.
        Phys Med. 2019; 62: 73-82
        • Talamonti C.
        • Russo S.
        • Pimpinella M.
        • et al.
        Community approach for reducing small field measurement errors: experience over 24 centres.
        Radiother Oncol. 2019; 132: 218-222
        • Esposito M.
        • Masi L.
        • Zani M.
        • et al.
        SBRT planning for spinal metastasis: indications from a large multicentric study.
        Strahlenther Onkol. 2018;
        • Giglioli F.R.
        • Clemente S.
        • Esposito M.
        • Fiandra C.
        • Marino C.
        • Russo S.
        • et al.
        Frontiers in planning optimization for lung SBRT.
        Phys Med. 2017; 44: 163-170
        • Mancosu P.
        • Pasquino M.
        • Reggiori G.
        • Masi L.
        • Russo S.
        • Stasi M.
        Dosimetric characterization of small fields using a plastic scintillator detector: a large multicenter study.
        Phys Med. 2017; 41: 33-38
        • Russo S.
        • Reggiori G.
        • Cagni E.
        • Clemente S.
        • Esposito M.
        • Falco M.D.
        • et al.
        Small field output factors evaluation with a micro Diamond detector over 30 Italian centers.
        Phys Med. 2016; 32: 1644-1650
        • Cagni E.
        • Russo S.
        • Reggiori G.
        • Bresciani S.
        • Fedele D.
        • Iori M.
        • et al.
        Technical note: multicenter study of TrueBeam FFF beams with a new stereotactic diode: can a common small field signal ratio curve be defined?.
        Med Phys. 2016; 43: 5570
        • Masi L.
        • Russo S.
        • Francescon P.
        • Doro R.
        • Frassanito M.C.
        • Fumagalli M.L.
        • et al.
        CyberKnife beam output factor measurements: a multi-site and multi-detector study.
        Phys Med. 2016; 32: 1637-1643
        • Russo S.
        • Masi L.
        • Francescon P.
        • Frassanito M.C.
        • Fumagalli M.L.
        • Marinelli M.
        • et al.
        Multicenter evaluation of a synthetic single-crystal diamond detector for CyberKnife small field size output factors.
        Phys Med. 2016; 32: 575-581
        • Giglioli F.R.
        • Strigari L.
        • Ragona R.
        • Borzì G.R.
        • Cagni E.
        • Carbonini C.
        • et al.
        Lung stereotactic ablative body radiotherapy: a large scale multi-institutional planning comparison for interpreting results of multi-institutional studies.
        Phys Med. 2016; 32: 600-606
        • Esposito M.
        • Maggi G.
        • Marino C.
        • Bottalico L.
        • Cagni E.
        • Carbonini C.
        • et al.
        Multicentre treatment planning inter-comparison in a national context: the liver stereotactic ablative radiotherapy case.
        Phys Med. 2016; 32: 277-283
        • Veronese I.
        • De Martin E.
        • Martinotti A.S.
        • Fumagalli M.L.
        • Vite C.
        • Redaelli I.
        • et al.
        Multi-institutional application of failure mode and effects analysis (FMEA) to cyberknife stereotactic body radiation therapy (SBRT).
        Radiat Oncol. 2015; 10: 132
        • Clemente S.
        • Nigro R.
        • Oliviero C.
        • Marchioni C.
        • Esposito M.
        • Giglioli F.R.
        • et al.
        Role of the technical aspects of hypofractionated radiation therapy treatment of prostate cancer: a review.
        Int J Radiat Oncol Biol Phys. 2015; 9: 182-195
        • Marino C.
        • Villaggi E.
        • Maggi G.
        • Esposito M.
        • Strigari L.
        • Bonanno E.
        • et al.
        A feasibility dosimetric study on prostate cancer: are we ready for a multicenter clinical trial on SBRT?.
        Strahlenther Onkol. 2015; 191: 573-581
        • Nagata Y.
        • Hiraoka M.
        • Mizowaki T.
        • Narita Y.
        • Matsuo Y.
        • Norihisa Y.
        • et al.
        Survey of stereotactic body radiation therapy in Japan by the Japan 3-D conformal external beam radiotherapy group.
        Int J Radiat Oncol Biol Phys. 2009; 75: 343-347
        • Pan H.
        • Simpson D.R.
        • Mell L.K.
        • Mundt A.J.
        • Lawson J.D.
        A survey of stereotactic body radiotherapy use in the United States.
        Cancer. 2011; 117: 4566-4572
        • Lock M.I.
        • Hoyer M.
        • Bydder S.A.
        • Okunieff P.
        • Hahn C.A.
        • Vichare A.
        • et al.
        An international survey on liver metastases radiotherapy.
        Acta Oncol. 2012; 51: 568-574
        • Daly M.E.
        • Perks J.R.
        • Chen A.M.
        Patterns-of-care for thoracic stereotactic body radiotherapy among practicing radiation oncologists in the United States.
        J Thorac Oncol. 2013; 8: 202-207
        • Guckenberger M.
        • Allgauer M.
        • Appold S.
        • Dieckmann K.
        • Ernst I.
        • Ganswindt U.
        • et al.
        Safety and efficacy of stereotactic body radiotherapy for stage 1 non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis.
        J Thorac Oncol. 2013; 8: 1050-1058
        • Bae S.H.
        • Lim M.S.
        • Jang W.
        • et al.
        A survey of stereotactic body radiotherapy in Korea.
        Cancer Res Treat. 2015; 47: 379-386
        • Distefano G.
        • Baker A.
        • Scott A.J.D.
        • Webster G.J.
        on behalf of the UK SABR consortium quality assurance group. Survey of stereotactic ablative body radiotherapy in the UK by the QA group on behalf of the UK SABR consortium.
        Br J Radiol. 2014; 87: 20130681
        • Dimitriadis A.
        • Kirkby K.J.
        • Nisbet A.
        • Clark C.H.
        Current status of cranial stereotactic radiosurgery in the UK.
        Br J Radiol. 2016; 89: 20150452
        • Knöös T.
        • Wieslander E.
        • Cozzi L.
        • et al.
        Comparison of dose calculation algorithms for treatment planning in external photon beam therapy for clinical situations.
        Phys Med Biol. 2006; 51: 5785-5807
        • Lechner W.
        • Wesolowska P.
        • Azangwe G.
        • et al.
        A multinational audit of small field output factors calculated by treatment planning systems used in radiotherapy.
        Phys. Imag. Radiat. Oncol. 2018; 5: 58-63
        • Menzel H.G.
        • et al.
        ICRU Report 91: prescribing, Recording, and Reporting of Stereotactic Treatments with Small Photon Beams.
        J. Int. Commission Radiat Units Measure. 2014; 14: 1-160
        • Tomita N.
        • Kodaira T.
        • Teshima T.
        • et al.
        Japanese structure survey of high-precision radiotherapy in 2012 based on institutional questionnaire about the patterns of care.
        Jpn J Clin Oncol. 2014; 44: 579-586
        • Nelms B.E.
        • Simon J.A.
        A survey on planar IMRT QA analysis.
        J Appl Clin Med Phys. 2007; 8: 2448