9 Reporting in Brachytherapy: Dose and Volume Specification

156 Reporting in Brachytherapy

- to build up progressively clinical experience in the department progressively resulting in improved techniques, - to be able to exchange information on treatment conditions with other centres, - to be able to „reconstruct“ the treatment conditions when needed: interpretation of the treatment outcome(s), accident, implementation of a quality assurance program, or a research and development program, etc. It is important that sufficient information be exchanged, and agreement be reached, between the medical, physics and radiographer staff, on the methods of recording the treatment parameters. The terms and concepts to be used should be clearly defined. The amount of information to be recorded depends on (1) the technique and the purpose of the treatment (cure or palliation), and (2) the situation of the department as far as equipment and staff is concerned. 1.1.3 Reporting the treatment Prescribing the treatment is the responsibility of the radiation-oncology team in charge of the patient, recording the treatment parameters is the responsibility of the department, but harmonisation in reporting is mandatory for the reliable exchange of information between centres. Harmonisation in reporting implies an agreement on (1) concepts and definitions of terms, and (2) a general approach on how to report a treatment. Agreement must also be reached on the (minimum) information that should be contained in the report. Because, however, of the huge amount of information now available in some situations, the part of this information, which is relevant for reporting, must be selected. Comparison of treatments performed in different centres using different treatment conditions implies agreement on a certain number of reference parameters. As a first basic option, reference points must be selected and the dose to these points can be compared. Alternatively, fixed dose levels can be selected and the dimensions of the corresponding volumes can be compared. In brachytherapy, the reference points can be related to anatomy or to the source and/or the applicator. In the past, selection of reference points was the most common approach for comparison. With advancing imaging and dosimetric techniques, the volume concept becomes a realistic option. For the future, the volume concept will probably be a major factor in the development of brachytherapy (as in external beam therapy) and will become more and more clinically relevant. Recommendations for improving harmonisation in reporting interstitial, intraluminal and intracavitary brachytherapy therapy are presented in this chapter on “reporting in brachytherapy”. However for the future, and without interfering with the prescription itself, nor with the local policy for recording the treatment parameters, it is obvious that all procedures would be simplified and faster, and the risk of confusion and accident would be reduced if the same definitions of terms and concepts and the same methods for specifying the doses and the volumes were used for prescribing, recording and reporting. This would also facilitate multi-centre research and cooperative clinical trials.