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As early as in 1982, the European Organisation for Research and Treatment of Cancer Radiotherapy Group established a quality assurance programme. In the course of 20 years, quality assurance procedures have become a vast and important part of the activities of the group. Today, the membership committee uses standard procedures based on minimal requirements to evaluate current members and new membership applications. Moreover, for every new trial, specific quality assurance procedures are an integral part of the preparation of the protocol and executed under the responsibility of the study coordinator. With the growing complexity of the radiotherapy techniques used in the framework of the more recent trials, quality assurance procedures have also become more complex including trial specific phantom based measurements. Future ways to evaluate all steps of the radiotherapy process using a common platform connecting all users with the internet are currently under development.

Radiation-induced nausea and vomiting (RINV) affect the management and quality of life of cancer patients. Current guidelines for RINV prevention recommend prophylaxis with a 5-hydroxytryptamine (5-HT(3))-receptor antagonist for patients receiving moderately or highly emetogenic radiotherapy regimens. Randomised trials have compared such antagonists with conventional antiemetics, and have demonstrated their efficacy and safety. Special consideration is needed for antiemetic treatment in certain patient groups, particularly the elderly and those with renal or hepatic impairment. Radiation oncologists should be aware of the effect on antiemetic treatment of factors such as comorbid conditions (particularly cardiovascular disease), polypharmacy and drug-drug interactions, and choose the agent with the lowest potential for additional complications. The most appropriate antiemetic treatment to improve patient compliance and quality of life should ideally combine proven efficacy with uncomplicated administration and convenient dosing regimens.

In 1982, the European Organization for Research and Treatment of Cancer (EORTC) Radiotherapy Group established the Quality Assurance (QA) programme. During the past 20 years, QA procedures have become a major part of the activities of the group. The methodology and steps of the QA programme over the past 20 years are briefly described. Problems and conclusions arising from the results of the long-lasting QA programme in the EORTC radiotherapy group are discussed and emphasised. The EORTC radiotherapy group continues to lead QA in the European radiotherapy community. Future challenges and perspectives are proposed.

Improvement in the accuracy of the positioning of the patient during external irradiation is one of the most important issues of the last decades, due to the detrimental impact of the misplacements on treatment outcome. Since 1990, the evolution of the technologic environment has led to a full integration of the portal imaging devices into linac technology. It offers a real on-line verification tool for "high-dose, high-accuracy" treatments. This overview based upon data from the literature describes the different types of imaging devices, the strategies of use and the results obtained. It also considers the use of imaging devices as an in vivo dosimeter.

The Radiotherapy group of the European Organisation for Research and Treatment of Cancer (EORTC-RT) has been performing quality assurance with mailed TL dosimetry since 1986. The programme consists of therapy machine output checks, in vivo measurements, and dosimetry for brachytherapy. The therapy machine output checks have revealed a few large deviations (greater than 7%) between EORTC-measured and institute-stated dose, but also shown an improvement in the dosimetry of the participating institutes as a result of consecutive mailings. The use of in vivo dosimetry with mailed TLD has proven that it is feasible to detect deviations of +/- 5%. The results have shown deviations within +/- 5% for dosimeters located well within the radiation field for internal measurements in the pelvic region. Dosimetry of brachytherapy has been performed for low dose rate 192Ir sources. Differences of 14% can be seen between the participating centres.

A quality assurance programme was activated in 1982 in the EORTC Cooperative Group of Radiotherapy. Definitions and contents of quality assurance and quality control, definitions of errors and deviations (systematic, occasional) are given. The methodology and steps of the quality assurance programme adopted over the past ten years are briefly described. The need for an interaction between national and international networks is emphasized. Consensus statements on quality assurance in radiotherapy provided during the January 1993 Geneva meeting conclude this introduction to the detailed reports on the quality assurance programme of the EORTC Cooperative Group of Radiotherapy.