Current practices of measurement-based patient-specific QA for radiotherapy treatments in France-Asurvey by the SFPM PSQA working group

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INTRODUCTION: In France, advances in radiotherapy techniques combined with the absence of national framework for patient-specific-quality-assurance (PSQA), have led each center to develop its own methodology. In 2024, the French Society of Medical Physics (SFPM) established a dedicated working group to develop national recommendations for PSQA implementation. As a preliminary step, a nationwide-survey was conducted to characterize current measurement-based PSQA practices across radiotherapy centers. MATERIALS AND METHODS: A comprehensive questionnaire (95 questions) was distributed to all radiotherapy centers in France, covering organizational aspects, machine-specific items, measurement-based PSQA systems and analysis methods. It included all photon-based radiotherapy machines nationwide. RESULTS: Seventy-one centers fully completed the survey; 68 were French radiotherapy centers (representing 40% of national centers), and three were French-speaking centers located outside France. 91% of centers reported performing systematic pre-treatment measurement-based PSQA. For conventional treatments, detector arrays and portal imagers were the most frequently used systems (46% and 41%, respectively). For stereotactic treatments, most frequently used systems were high-resolution arrays (39%), point-detectors (25%) and portal imagers (23%). 95% of centers performed quantitative gamma-index analysis. Substantial variability was observed in analysis protocols with 80 distinct combinations reported. 61% of participants reported out-of-tolerance measurement-based PSQA in fewer than 1% of cases, mainly related to related to machine performance degradation (76%). 55% of respondents would consider partially discontinuing measurements-based PSQA. CONCLUSION: Systematic measurement-based PSQA remains widely practiced in France, despite heterogeneous methods and growing questioning of its added value. This working group will next evaluate alternatives to support the development of national recommendations for safer and more efficient treatment preparation.

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