Exhibit Hall | Forum 7
Purpose: While the value of on-site peer review for proton therapy has been published, recent events have required ingenuity to adapt a program that heavily relied on in-person measurements and interactions.
Methods: In the past two years, the Imaging and Radiation Oncology Core (IROC) has performed modified remote audits for 8 proton centers participating in NCI clinical trials. Several tests that were previously performed in person, such as the CT-Relative Linear Stopping Power (RLSP) evaluation, proton-IGRT coincidence test, and clinical workflow and QA reviews, were done remotely. Ion chamber measurements of beam calibration, range, and field verification could not be completed remotely as part of this virtual test framework (and will be done at a later time).
Results: Proton institutions received an average of 1 (range: 1-2) recommendation for practice improvements from remote audits, compared to an average of 3 (range: 1-8) from on-site audits. The most common deficiencies were for Task Group-recommended QA compliance (100% of centers) and CT-RLSP conversion (25%), which mirrored the same errors most frequently identified during on-site audits. In a review of on-site proton audit recommendations from 2010-2020, 80% of the deficiencies would have been identified by a remote review program. However, the severity of errors identified through ion chamber measurements are likely higher than errors identified with remote review (e.g. beam modeling error), suggesting the on-site component has an important role.
Conclusion: While remote proton audits miss some errors previously identified with on-site ion chamber-based measurements, they are nonetheless an effective tool to catch other programmatic errors. We recommend integrating remote review as a peer review tool to compliment on-site audits.
Funding Support, Disclosures, and Conflict of Interest: This work was supported by a grant from the National Cancer Institute.
Protons, Quality Assurance, Clinical Trials
TH- External Beam- Particle/high LET therapy: Proton therapy – quality assurance