User Expectations and Current Availability of HDR Brachytherapy Audits In Europe
Abstract
Purpose
The aim of this work was to evaluate the need to implement more dosimetric audits in high‐dose‐rate brachytherapy (HDR-BT) in Europe and to identify which characteristics such audits should meet according to users.
Methods
A 30 multiple-choice survey was developed using Google Forms and distributed among European centers, with an estimated completion time <15 minutes. It was disseminated through professional societies, mailing lists, and vendors. The questionnaire collected information on center characteristics, clinical practice, previous audit participation, desired audit features, and opinions on whether current audit services are sufficient or whether more services are needed.
Results
Seventy-four European centers completed the survey. Most respondents (95%) used ¹⁹²Ir, while only two centers used ⁶⁰Co and two electronic BT. Regarding the role of audits, 61% thought that HDR-BT dosimetry audits should be recommended but not mandatory, whereas 35% considered them necessary and compulsory. Despite this perceived need, only 14% reported access to any audit service, typically through pilot or research initiatives rather than permanent programs. A large majority (86%) indicated that current HDR-BT audit availability is insufficient and that more national or international services are required. Importantly, 99% stated they would participate in an HDR-BT audit if available. Users also identified desirable audit characteristics (see supplement material), including aspects to be tested, recommended frequency, time requirements, and technical conditions.
Conclusion
This survey reveals a strong mismatch between the very limited access to HDR-BT audits in Europe and the strong consensus on their necessity. Users also provided clear indications of what such audits should meet, offering guidance for future development. Stronger recommendations from organizations and societies are needed to expand audit infrastructures and establish independent dosimetric verification as a standard component of quality assurance in HDR-BT.