Report
American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Performance of Stereotactic Body Radiation Therapy

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Preamble

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

The ultimate

Qualifications and Responsibilities of Personnel

See the ACR Practice Guideline for Radiation Oncology (1) where qualifications, credentialing, professional relationships, and development are outlined. The following are minimal recommendations for staffing levels and staff responsibilities while participating in an SBRT procedure. Specific duties may be reassigned where appropriate.

Specifications of the Procedure

The accuracy and precision of SBRT treatment planning and delivery are critical. The treatment-delivery unit requires the implementation of, and adherence to, an ongoing QA program. The mechanical tolerance of the radiation delivery apparatus should be appropriate for the clinical task. Additional tolerances to account for setup error and variation of target localization may be applied, and these are detailed in section VI. Precision should be validated by a reliable QA process. It is

Documentation

Reporting should be in accordance with the ACR Practice Guideline for Communication: Radiation Oncology (2).

Quality Control and Improvement, Safety, Infection Control, and Patient Education

Relative to conventional radiation therapy treatments, SBRT is an image-guided process that requires increased precision in the positioning of the treatment beams directed to the target tissues. Thus, SBRT QA must guarantee that both the image-guided system and the treatment delivery system are functioning within acceptable tolerances. In addition, it is essential that the QA process also guarantees that these 2 systems communicate such that the information gathered by the imaging system

Simulation and Treatment

The tolerance for radiation targeting accuracy, which includes accounting for systematic and random errors associated with setup and target motion, needs to be determined for each different organ system in each department performing the SBRT by actual measurement of organ motion and setup uncertainty.

Follow-up

There should be follow-up of all patients treated, and appropriate records should be maintained to determine local control, survival, and normal tissue injury. As with any form of radiation therapy, there is a potential risk of subacute or late toxicity that may occur months or even years after treatment. The data should be collected in a manner that complies with statutory and regulatory peer-review procedures to protect the confidentiality of the peer-review data.

Summary

The quality of a stereotactic body radiation therapy program depends on the coordinated interactions of a team of skilled health care professionals. A high degree of spatial accuracy is necessary in the treatment planning and delivery process. Since SBRT uses either single-fraction treatment or a hypofractionated regimen, there is little chance for adjustment once treatment has been initiated. This demands considerable time for planning and treatment verification by the radiation oncologist and

Acknowledgment

This guideline was developed collaboratively with ACR according to the process described in both the ACR Practice Guidelines and Technical Standards CD and the ASTRO Process for Collaborative Guidelines and Technical Standards with other societies.

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References (2)

  • Practice guidelines and technical standards

    (2008)
  • Radiation oncology. Practice guidelines and technical standards

    (2008)

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Reprint requests to: Department of Research, American Society for Therapeutic Radiology and Oncology (ASTRO), 8280 Willow Oaks Corporate Drive, Suite 500, Fairfax, VA 22031. Tel: (703) 502-1550; Fax: (516) 470-8445; E-mail: [email protected]

This report was previously published as American College of Radiology Practice Guideline for the Performance of Stereotactic Body Radiation Therapy, ACR Practice Guidelines and Technical Standards CD, 2009.

Conflict of interest: none.

© 2010 American Society for Therapeutic Radiology and Oncology and American College of Radiology

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