Vol.:(0123456789) 1 3 Australas Phys Eng Sci Med (2017) 40:811–822 DOI 10.1007/s13246-017-0590-y SCIENTIFIC PAPER A survey of modulated radiotherapy use in Australia & New Zealand in 2015 Jefrey Barber 1,2  · Philip Vial 2,3  · Paul White 4  · Nick Menzies 5  · Shrikant Deshpande 3  · Regina Bromley 6  · Nick Bennie 7  · Shan Yau 1  · Kristie Harrison 8   Received: 11 August 2017 / Accepted: 28 September 2017 / Published online: 12 October 2017 © Australasian College of Physical Scientists and Engineers in Medicine 2017 Keywords IMRT · VMAT · Modulated therapy Introduction Since its initial implementation in the 1990s [1], Intensity Modulated Radiation Therapy (IMRT) has changed the prac- tice of radiotherapy [2]. The improved dose distributions that can be achieved allow for treatments which target disease and spare healthy tissue, which has been shown to improve quality of life, cosmesis and allow for dose escalation [3–6]. The technology and clinical practice of IMRT has evolved continuously since its initial implementation. Examples of technological advancement in IMRT include rotational treat- ments such as TomoTherapy and conventional linear accel- erator based Volumetric Modulated Arc Therapy (VMAT). In this survey the generic term ‘modulated therapies’ is used to describe all of the modulated delivery techniques that are based on volumetric inverse planning (unless otherwise stated). Practice guidelines for commissioning and use of mod- ulated therapies have been developed by several groups [7–12]. Despite these documents, the methods and equip- ment used by medical physicists to commission and conduct quality assurance (QA) of modulated therapies has always been heterogeneous. There have been regional physicist sur- veys of IMRT QA [13] and use [14] in the USA, UK [15] and India [16], as well as informal email list surveys. These have revealed inconsistencies and diferences in practice. How best to implement and perform quality control of mod- ulated therapies remains a controversial topic in radiation oncology medical physics [17]. In the Australasian context, previous surveys of modulated therapy practice patterns from other specialities within radiation oncology have had Abstract A survey of radiation oncology medical physics departments across Australia and New Zealand was con- ducted to assess the usage, commissioning and quality assur- ance of modulated radiotherapy techniques such as IMRT and VMAT. Survey responses were collected in April–May 2015 to snapshot current practice and historical implemen- tation. The survey asked 142 questions, and is the most detailed survey of its kind published to date. Analysis of results at overall department level, as well as sub-analysis for diferent equipment and techniques in use, was performed. Results show a high prevalence of IMRT and VMAT in use, and demonstrate the large heterogeneity in clinical practice and experience across the region. Electronic supplementary material The online version of this article (doi:10.1007/s13246-017-0590-y) contains supplementary material, which is available to authorized users. * Jefrey Barber jefrey.barber@health.nsw.gov.au 1 Sydney West Radiation Oncology Network, Sydney, NSW, Australia 2 School of Physics, Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia 3 Liverpool & Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, NSW, Australia 4 Nelune Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia 5 Riverina Cancer Care Centre, Wagga Wagga, NSW, Australia 6 Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia 7 North Coast Cancer Centre, Lismore Base Hospital, Lismore, NSW, Australia 8 Genesis Cancer Care NSW, Newcastle, NSW, Australia