1. The RPC Proton Therapy Approval Process
Welcome to the RPC.
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)..

2. 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

3. 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

4. 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

5. 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 p⁺

6. Electronic Data Transfer
Institutions must be able to submit treatment plans electronically to the ITC
Data used for RPC phantom audits, study group credentialing

7. RPC Proton Phantom Program
Baseline phantoms:
Scattered, uniform scanning: prostate & spine
Spot scanning: Lung, head, prostate

8. 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

9. RPC Proton Site Visits Typical review components:
Dosimetry equipment calibration
CT scanner, CTN/RSP conversion
Patient immobilization
Treatment planning procedures
QA documentation

10. 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

11. 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

12. Questions?

13. 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

14. 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

15. Most measurements at mid-SOBP ± 2 cm
RPC Proton TLD Program
Most measurements at mid-SOBP ± 2 cm 15

16. MR image fused with CT for prescription and dose calc
Brain Phantom
Selected Phantom Lab “Alderson” phantom
Materials fall on CT#-RLSP curve
Contains realistic bony anatomy
Inserts with target and dosimetry will be constructed
MR image to define CTV
MR image fused with CT for prescription and dose calc 16

17. Lung Phantom 17