Study of quality assurance regulations for linear accelerators in Korea: A comparison study between the current status in Korea and the international guidelines

TL;DR

This study compares Korean hospital QA protocols for linear accelerators with international guidelines, revealing significant discrepancies and emphasizing the need for standardized national QA procedures to ensure consistent cancer treatment quality.

Contribution

It provides a comprehensive comparison of Korean hospital QA protocols with international standards, highlighting gaps and proposing the development of standardized QA items and procedures.

Findings

Low concordance rates in daily and weekly QA items between Korean hospitals and international guidelines.

Korean QA protocols do not meet international standards, especially in frequency and comprehensiveness.

Need for national standardization of QA items and procedures for linear accelerators.

Abstract

Quality assurance (QA) for medical linear accelerators is indispensable for appropriate cancer treatment. Some international organizations and western advanced countries provide QA guidelines for linear accelerators. Currently, QA regulations for linear accelerators in Korean hospitals specify a system in which each hospital stipulates its independent hospital-based protocols for QA procedures (HP_QAPs) and conducts QA based on these HP_QAPs while regulatory authorities verify whether items under these HP_QAPs have been performed. However, because this regulatory method cannot guarantee the quality of universal treatment, and QA items with tolerance criteria are different in many hospitals, the presentation of standardized QA items and tolerance criteria is essential. In this study, QA items in HP_QAPs from various hospitals and those presented by international organizations. Concordance rates between QA items for linear accelerators that were presented by the aforementioned organizations and those currently being implemented in Korean hospitals were shown to exhibit a daily QA of 50%, a weekly QA of 22%, a monthly QA of 43%, and an annual QA of 65%, and the overall concordance rates of all QA items were approximately 48%. In comparison between QA items being implemented in Korean hospitals and those being implemented in western advanced countries, concordance rates were shown to exhibit a daily QA of 50%, a weekly QA of 33%, a monthly QA of 60%, and an annual QA of 67%, and the overall concordance rate of all QA items were approximately 57%. The results of this study indicate that the HP_QAPs currently implemented by Korean hospitals as QA standards for linear accelerators used in radiation therapy do not meet international standards. To solve this problem, it is necessary to develop national standardized QA items and procedures for linear accelerators.