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The RPC Proton Therapy Approval Process. Paige Summers, MS This project is supported by the Federal Share of program income earned by Massachusetts General Hospital on C06 CA059267, Proton Therapy Research and Treatment Center and by grants CA10953 and CA81647 (NCI, DHHS).

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the rpc proton therapy approval process
The RPC Proton Therapy Approval Process

Paige Summers, MS

This project is supported by the Federal Share of program income earned by Massachusetts General Hospital on C06 CA059267, Proton Therapy Research and Treatment Center and by grants CA10953 and CA81647 (NCI, DHHS)..

rpc s proton involvement
RPC’s Proton Involvement
  • Asked by the NCI to help ensure cooperative groups that proton centers are delivering clinically comparable and consistent dose
    • Proton visits funded in part by NCI/MGH shared funds
    • 10 clinical sites

(8 in trials)

    • Forecast 18 new sites
    • NCI/MGH funds

extended until 12/31/12

proton approval steps
Proton Approval Steps
  • Proton facility questionnaire
  • Annual monitoring of beam calibrations by the RPC
  • Ability to electronically transfer treatment plans
  • Successful irradiation of RPC’s baseline proton phantoms
  • Successful completion of on-site dosimetry review visit
facility questionnaire
Facility Questionnaire
  • AAPM Proton Advisory group aids RPC in updating proton facility questionnaire
  • Questions covered:
    • Experiences in the clinic
    • Dose calibration & verification
    • Proton beam production & delivery
    • Treatment Planning
    • Immobilization
    • Patient Alignment
    • QA
annual beam audit rpc tld
Annual Beam Audit – RPC TLD
  • Ten proton centers monitored
  • In process of switching from TLD to OSLD to monitor beam output annually
  • Plan to use dosimeters for depth dose measurements


electronic data transfer
Electronic Data Transfer
  • Institutions must be able to submit treatment plans electronically to the ITC
  • Data used for RPC phantom audits, study group credentialing
rpc proton phantom program
RPC Proton Phantom Program
  • Baseline phantoms:
    • Scattered, uniform scanning: prostate & spine
    • Spot scanning: Lung, head, prostate
rpc proton site visits
RPC Proton Site Visits
  • NCI/RPC recommend institutions only visited after center has been routinely treating patients for minimum of 6 months with no fewer than 3 disease sites
  • Different delivery modalities have separate audit requirements – must each be reviewed
  • Prioritization dependent on inst. initiative, membership in cooperative groups, readiness
  • Dosimetric and imaging quality evaluation criteria being developed
rpc proton site visits1
RPC Proton Site Visits
  • Typical review components:
    • Dosimetry equipment calibration
    • CT scanner, CTN/RSP conversion
    • Patient immobilization
    • Treatment planning procedures
    • QA documentation
rpc proton site visits2
RPC Proton Site Visits
  • Typical site visit measurements
    • Beam calibration comparison – RPC/Inst
    • CAX lateral and depth dose profiles for reference and patient fields
    • Scanning beam – less fields tested, more profiles obtained
    • X-ray system measurements
    • TLD measurements
rpc proton site visits3
RPC Proton Site Visits
  • After visits, RPC generates comprehensive site visit report – sent to institution with recommendations
  • If measurements and procedures pass criteria, approval letter sent to institution, ITC, RTOG, & QARC

rpc proton phantom program1
RPC Proton Phantom Program
  • Goals:
    • Implement use of OSLD for phantom audits
    • Modify existing phantoms for proton use
      • Liver: multiple targets
      • Lung: motion
      • Prostate: proton equivalent
      • Head: H&N target

Proton liver insert – blue water replaces polystyrene

rpc s proton goals
RPC’s Proton Goals
  • Proton facility questionnaire
    • Have existing facilities update
    • Set up facility questionnaire online
  • OSLD for phantom audits
  • Adapt site visit procedures for new proton technologies
    • Scanning beams, MevIon systems

RPC Proton TLD Program

Most measurements at mid-SOBP ± 2 cm

brain phantom
Brain Phantom

Selected Phantom Lab “Alderson” phantom

Materials fall on CT#-RLSP curve

Contains realistic bony anatomy

Inserts with target and dosimetrywill be constructed

MR image to define CTV

MR image fused with CT for prescription and dose calc