A commissioning procedure for breast intracavitary electronic brachytherapy systems

In this work, we report a comprehensive quality assurance (QA) process for the commissioning of an Electronic Brachytherapy (EB) system at one of the first U.S. sites to apply the device clinically. Thus far, EB systems have been released only for intracavitary breast treatments. As such, EB as an Accelerated Partial Breast Irradiation (APBI) treatment modality is relatively unstudied and is unfamiliar to many medical physicists. We present our documented experience as a guide for other institutions' EB commissioning process. Our tests included eight elements: A) well-chamber constancy, B) beam stability, C) source positional accuracy, D) output stability, E) timer linearity, F) dummy marker/source position coincidence, G) controller functionality and safety interlocks, and H) treatment planning data verification following the AAPM TG-43 recommendations. Together with TG-43, our methodology provides a comprehensive EB system check for medical physicists commissioning such a device.