White Papers and Guidelines
Risk Assessment of Patient-Specific Quality Assurance (PSQA) Methods in Particle Therapy
A white paper on the optimization of patient-specific QA in PT is currently being finalized and has been submitted as a draft for approval as an official PTCOG report:
To date, PSQA using phantom measurements is common practice in most PT centres but has been criticized for its limited potential for error detection and high workload. With access to machine protocols and advanced dose calculations (especially Monte Carlo), many centres are reconsidering the need for measurement based PSQA, while discussing concerns about the safety and efficacy of alternative PSQA methods. Based on discussions and workshops starting in 2015, a working group of the PTCOG Treatment Efficiency Subcommittee evaluated since 2020 measurement-based, log file-based PSQA and (independent) secondary dose calculations. The aim is to provide the PT community with recommendations on these different approaches. The working group is composed of international experts using different devices and treatment procedures.
A risk assessment was performed using a similar process-based FMEA formalism as described in the AAPM TG-100 report. The roles of OIS, TPS, TDS and their data communication were considered. A generic workflow based on the processes of the participating institutes was developed, failure modes were identified for each step and finally those process steps were selected that could potentially influence PSQA applications. The workflow thus reduced to PSQA-relevant process steps was assessed once without any PSQA measures in place to form a risk baseline. It was then re-evaluated three times applying the respective, specific PSQA method. The associated risk mitigation steps were successively introduced in two FMEA iterations, first considering data transfer and then the full PSQA process. The average risk priority numbers (RPN) were calculated per process step, from which the average risk reductions per PSQA method were then extrapolated, according to their two-stage introduction.
PSQA-related data transfer slightly increased the average risk for all three PSQA methods (measurement-based: 7.8%; secondary dose calculation: 5.0%; protocol-based: 0.1%). However, when considering the complete PSQA processes, all methods led to a risk reduction. The protocol-based PSQA showed the most significant risk reduction (-39.2%), followed by the measurement-based method (-31.8%). Secondary dose calculation contributed the least (-6.8%). A combination of secondary dose calculation with measurement-based or protocol-based PSQA led to an average risk reduction of -36.7% or -45.3%, respectively, over the entire workflow, which makes their combined use appear reasonable. The identification of individual process steps where the risk could increase above the baseline value due to the (inappropriate) application of individual PSQA measures, which would therefore require further, individual precautionary measures, also appeared noteworthy.
In summary, the following conclusions were drawn:
- Log file-based PSQA is on average less risky and more efficient than the measurement-based method. It requires less equipment and allows testing of treatment fields under the same conditions as patient treatment. In addition, log files support adaptive proton therapy and facilitate the assessment of treatment quality immediately after delivery.
- Measurement-based PSQA continues to be a valuable approach to risk reduction. Log file and measurement based PSQA do not mitigate all risks equally, and for certain risks, one method may be more beneficial than the other.
- An independent secondary dose calculation is necessary when centres move away from measurement based PSQA. It is strongly recommended that either the primary or secondary calculation is an accurate Monte Carlo dose calculation.
- Quality control of protocol data and all data transfers is required for safe use of log file based PSQA.
- Proper commissioning, including phantom-based measurements, is strongly recommended when introducing new techniques or treatment sites.
This report summarizes the latest status of a white paper draft envisaged for internal PTCOG publication in the near future. To improve the general data basis, a web-based survey is currently underway that allows the specific application of the PSQA FMEA described for each PT facility individually. If you are interested in participating, please contact Daniel Robertson (see authorship).
Abbreviations:
FMEA failure modes and effects analysis
OIS oncology information systems
PSQA patient-specific quality assurance
PT particle/proton therapy
TDS treatment delivery system
TPS treatment planning system
Authors: Daniel Robertson1, Christina Vallhagen Dahlgren2, Chin-Cheng Chen3, Heng Li4, Niek Schreuder5, Chris Beltran6, Jay Flanz7, Frank Emert8
1 Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA,
(
2 The Skandion Clinic, Uppsala, Sweden
3 St. Jude Children’s Research Hospital,
4 Johns Hopkins Medicine
5 LEO Cancer Care, Knoxville, Tennessee, USA
6 Mayo Clinic, Jacksonville, Florida, USA
7 Harvard Medical School, Cambridge, MA, USA; Retired
8 Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
2024 PTCOG Annual Conference News
PTCOG 62, 10 - 15 June 2024, in Singapore, organized together with PTCOG-AO
Letter from the Organizers
Dear Colleagues,
On behalf of the PTCOG Executive Committee and of the Local Organizing Committee, we are pleased to invite you to Singapore for the 62nd edition of the PTCOG Annual Meeting. Singapore was recently named the most beautiful city in Asia and will surprise you with its fantastic food and amazing landscape. With 3 proton therapy centres and 6 gantries in a population of only 5.4 million, Singapore is the country with the highest number of proton therapy rooms per inhabitant worldwide. A perfect location for PTCOG 62!
The conference this year will start with a two-day educational session followed by 3-days of multi-session scientific reports with several subcommittee meetings in between. The conference theme is “Advancing Particle Therapy Through Collaborative Synergies“, stressing the importance of collaboration in the field of particle therapy. We expect an outstanding scientific program covering clinics, physics, and biology topics, many plenary talks, and round tables for debating hot issues in particle therapy.
Owing to the exceptional growth of proton therapy centres worldwide, PTCOG reached now over 4,000 members and nearly 100 facility representatives in the Steering Committee. PTCOG 61 in Madrid reached a record number of 1,600 participants on site, demonstrating the growing interest and research in particle therapy. PTCOG has now 17 active Subcommittees that will report their activities in a dedicated session during the scientific meeting. You are welcome to join these Subcommittees any time. This will be the first year where the new Early Career Researcher (ECR) Subcommittee will be involved in the educational and scientific program planning, resulting in a higher involvement of the younger generations in the PTCOG leadership and in the meeting. We will also discuss PTCOG funding for small research projects and the future of the PTCOG Scientific journal, the International Journal of Particle Therapy, that just got the first impact factor. The Steering Committee will be called to elect new members of the Executive Committee and to decide the site of the 2027 PTCOG annual meeting in Asia.
We look forward to your participation and spending time with you in Singapore. We are sure that this will be an awesome scientific experience and we also hope you will enjoy the local flavour and hospitality.
Welcome to PTCOG 62!
Marco Durante,
PTCOG Chairman
Martin Jermann,
PTCOG Secretary
Michael Wang Lian Chek,
Local Organizing Committee
Youngyih Han,
PTCOG-AO Chair
Upcoming Conferences
- 08-11 April, 2024: The EURADOS Annual Meeting takes place in Oxford. https://eurados.sckcen.be/events-overview/eurados-annual-meeting-2024-oxford-uk
- 03-07 May, 2024: The ESTRO Meeting is held in Glasgow. https://www.estro.org/Congresses/ESTRO-2024
- 10-15 June, 2024, 62nd Annual PTCOG Conference in Singapore. https://ptcog62.org/
- 24-28 June, 2024: The International Congress on Neutron Capture Therapy will convene in Krakow. https://icnct20.org/
- 21-26 July, 2024: The 27th International Conference on the Application of Accelerators in Research and Industry (CAARI) and the 54th Symposium of Northeastern Accelerator Personnel (SNEAP) will be held at the Worthington Renaissance Hotel in Fort Worth, TX. https://caari-sneap.com/
- 10-13 September: 48th European Radiation Research Society (ERRS) Meeting. https://errs2024.pt/general-info/
- 11-14 September, 2024: The European Congress of Medical Physics will meet in Garching by Munich. https://ecmp2024.org/
- 15-18 September: Radiation Research Society (RRS) meeting. https://www.radres.org/
- 22-27 September: Applied Nuclear Physics (ANP) Conference. https://radium.phys.uoa.gr/ANP2024/
- 29 September to 02 October, 2024: The ASTRO Annual Meeting is in Washington DC. https://www.astro.org/Meetings-and-Education/Micro-Sites/2024/Annual-Meeting
- 18 October, 2024: The Annual Meeting of the German BNCT Society in Würzburg. https://dgbnct.de
- 21-22 October, 2024: 8th European Particle Therapy (EPTN Meeting) in Vienna https://www.estro.org/Science/EPTN
- 14-16-November, 2024: 10th PTCOG-NA Annual Meeting in New York City https://ptcog-na.org/ptcog-na-10th-annual-meeting
- 4-6 December: FLASH Radiotherapy & Particle Therapy (FRPT). https://frpt-conference.org/
International Journal of Particle Therapy (IJPT) Update
Early Career Authors and the New IJPT Partnership with Elsevier
This January, the Particle Therapy Co-Operative Group (PTCOG) and the International Journal of Particle Therapy (IJPT) were pleased to announce IJPT’s new publishing partnership with Elsevier.
The collaboration offers many benefits for PTCOG Early Career authors, as it will greatly enhance IJPT’s journal reach and impact. Founded in 1880, Elsevier is part of the RELX Group, a publicly traded company headquartered in Amsterdam with worldwide offices. The company’s robust academic publishing presence; multiple peripheral marketing and advertising services; ownership of, and direct support for, Aries, IJPT’s current Editorial Manager peer review system; and access to PlumX Metrics, incorporated into its Scopus, ScienceDirect, Pure, Digital Commons and SSRN research products represent just a few of the advantages available to journal partners.
These advantages bolster PTCOG’s and IJPT Editorial Board efforts to assure that the journal provides an efficient means for dissemination of peer-reviewed information regarding particle therapy; becomes the preferred location for publication of all types of information regarding particle therapy; enhances the quality of particle therapy publications through dedicated and creative editorial assistance; facilitates career development of young particle therapy investigators; and embraces all aspects of diversity by welcoming multiple approaches and points of view that foster diversity and inclusion in research, writing, and review, while mitigating bias.
In addition, IJPT received its first Impact Factor of 1.7 last June and continues to maintain a strong 3.9 CiteScore, placing it in the 58th percentile among journals in the Radiology, Nuclear Medicine and Imaging category. For perspective on this ranking, the CiteScores for Practical Radiation Oncology and Advances in Radiation Oncology are 4.6 (67th percentile), and 4.5 (65th percentile), respectively. And while IJPT readership is relatively small (particle therapy accounts for <1% of radiation facilities and ≤2% of radiation treatments in the US and <1% across the globe), IJPT Impact Metrics and overall readership are expected to steadily improve as an Elsevier journal.
The new IJPT website is featured on Elsevier’s ScienceDirect publishing platform, considered to be one of the world’s largest, attracting approximately 19 million unique visitors each month. To submit your manuscript for consideration, visit the IJPTIJPT Editorial Manager website.
Nancy Mendenhall, Editor-in-Chief IJPT
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Industry News
RaySearch
With the 2023B release in June of 2023, RaySearch introduced proton arc therapy planning in RayStation, a technique that gives more conformal dose distributions and less dose to risk organs compared to conventional IMPT plans. Since dynamic proton arc therapy is not yet supported by any delivery system, this first release is limited to the creation of discrete proton arcs, where an arc beam is delivered from many discrete angles, but where no protons are delivered while the gantry is moving.
Development ongoing in areas such as auto-replanning tailored for online adaptive treatments, accelerated optimization using the GPU, extended support for upright treatments, FLASH (under development for investigational purposes, safety, and efficacy to be determined. Not currently available for clinical use), and multi-ion treatment planning. RaySearch intends to continue to support all new delivery systems and treatment techniques that emerge on the market.
TAE Life Sciences (TAELS)
The Centro Nazionale di Adroterapia Oncologica (CNAO) in Pavia (Italy) preparing the Installation of TAELS Alphabeam® BNCT system.
Franciszek Łukaszczyk Oncology Centre (FLOC) in Poland has announced to collaborate with TAELS for building up a BNCT Centre using TAE LS Alphabeam® BNCT system.
TAE Life Sciences has earned the 2023 Biotech Breakthrough Award for Oncology Innovation of the Year.
A recently published article by TAELS drug development branch (J. Med. Chem. 2023, 66, 19, 13809–13820) identifies Boronotyrosine (BTS) a promising drug candidate for BNCT. BTS outperforms conventional Boronophenylalanine (BPA) in both in vitro and in vivo models. Notably, BTS exhibited a 2- to 4-fold greater cellular uptake in vitro compared to BPA, with significantly higher boron retention within cancer cells after 18 hours. These results translated into improved boron delivery over longer periods in in vivo experiments, and a notably higher tumour-to-blood ratio compared to BPA. These findings underscore the potential of BTS to enhance the efficacy of BNCT while minimizing damage to healthy tissues. An agreement with Biddle Sawyer to exclusively manufacture our BTS drug has been achieved.
Neutron Therapeutics
Neutron Therapeutics has installed their nuBeam® compact accelerator at Shonan Kamakura General Hospital (SKGH), in Kanagawa Prefecture, Japan. In the photo, they stand in the treatment room in front of the accelerator. From left to right: Dr. Shinichi Gotoh, of SKGH; Dave Greenwald, CEO of Aviko; Tori Fleek, business development lead at Aviko; Noah Smick, president and COO of Neutron Therapeutics; and Colin Buckley of Buckley Systems.
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