Multi-institutional consensus on machine QA for isochronous cyclotron-based systems delivering ultra-high dose rate (FLASH) pencil beam scanning proton therapy in transmission mode.
FLASH
machine QA
ultra-high dose rate
Journal
Medical physics
ISSN: 2473-4209
Titre abrégé: Med Phys
Pays: United States
ID NLM: 0425746
Informations de publication
Date de publication:
16 Dec 2023
16 Dec 2023
Historique:
revised:
07
10
2023
received:
23
04
2023
accepted:
31
10
2023
medline:
17
12
2023
pubmed:
17
12
2023
entrez:
16
12
2023
Statut:
aheadofprint
Résumé
The first clinical trials to assess the feasibility of FLASH radiotherapy in humans have started (FAST-01, FAST-02) and more trials are foreseen. To increase comparability between trials it is important to assure treatment quality and therefore establish a standard for machine quality assurance (QA). Currently, the AAPM TG-224 report is considered as the standard on machine QA for proton therapy, however, it was not intended to be used for ultra-high dose rate (UHDR) proton beams, which have gained interest due to the observation of the FLASH effect. The aim of this study is to find consensus on practical guidelines on machine QA for UHDR proton beams in transmission mode in terms of which QA is required, how they should be done, which detectors are suitable for UHDR machine QA, and what tolerance limits should be applied. A risk assessment to determine the gaps in the current standard for machine QA was performed by an international group of medical physicists. Based on that, practical guidelines on how to perform machine QA for UHDR proton beams were proposed. The risk assessment clearly identified the need for additional guidance on temporal dosimetry, addressing dose rate (constancy), dose spillage, and scanning speed. In addition, several minor changes from AAPM TG-224 were identified; define required dose rate levels, the use of clinically relevant dose levels, and the use of adapted beam settings to minimize activation of detector and phantom materials or to avoid saturation effects of specific detectors. The final report was created based on discussions and consensus. Consensus was reached on what QA is required for UHDR scanning proton beams in transmission mode for isochronous cyclotron-based systems and how they should be performed. However, the group discussions also showed that there is a lack of high temporal resolution detectors and sufficient QA data to set appropriate limits for some of the proposed QA procedures.
Sections du résumé
BACKGROUND
BACKGROUND
The first clinical trials to assess the feasibility of FLASH radiotherapy in humans have started (FAST-01, FAST-02) and more trials are foreseen. To increase comparability between trials it is important to assure treatment quality and therefore establish a standard for machine quality assurance (QA). Currently, the AAPM TG-224 report is considered as the standard on machine QA for proton therapy, however, it was not intended to be used for ultra-high dose rate (UHDR) proton beams, which have gained interest due to the observation of the FLASH effect.
PURPOSE
OBJECTIVE
The aim of this study is to find consensus on practical guidelines on machine QA for UHDR proton beams in transmission mode in terms of which QA is required, how they should be done, which detectors are suitable for UHDR machine QA, and what tolerance limits should be applied.
METHODS
METHODS
A risk assessment to determine the gaps in the current standard for machine QA was performed by an international group of medical physicists. Based on that, practical guidelines on how to perform machine QA for UHDR proton beams were proposed.
RESULTS
RESULTS
The risk assessment clearly identified the need for additional guidance on temporal dosimetry, addressing dose rate (constancy), dose spillage, and scanning speed. In addition, several minor changes from AAPM TG-224 were identified; define required dose rate levels, the use of clinically relevant dose levels, and the use of adapted beam settings to minimize activation of detector and phantom materials or to avoid saturation effects of specific detectors. The final report was created based on discussions and consensus.
CONCLUSIONS
CONCLUSIONS
Consensus was reached on what QA is required for UHDR scanning proton beams in transmission mode for isochronous cyclotron-based systems and how they should be performed. However, the group discussions also showed that there is a lack of high temporal resolution detectors and sufficient QA data to set appropriate limits for some of the proposed QA procedures.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.
Références
Favaudon V, Caplier L, Monceau V, et al. Ultrahigh dose-rate FLASH irradiation increases the differential response between normal and tumor tissue in mice. Sci Transl Med. 2014;6(245). doi:10.1126/scitranslmed.3008973
Montay-Gruel P, Petersson K, Jaccard M, et al. Irradiation in a flash: unique sparing of memory in mice after whole brain irradiation with dose rates above 100 Gy/s. Radiother Oncol. 2017;124(3):365-369. doi:10.1016/j.radonc.2017.05.003
Vozenin M-C, de Fornel P, Petersson K, et al. The advantage of FLASH radiotherapy confirmed in Mini-pig and Cat-cancer patients. Clin Cancer Res. 2019;25(1):35-42. doi:10.1158/1078-0432.CCR-17-3375
Bourhis J, Sozzi WJ, Jorge PG, et al. Treatment of a first patient with FLASH-radiotherapy. Radiother Oncol. 2019;139:18-22. doi:10.1016/j.radonc.2019.06.019
Gaide O, Herrera F, Jeanneret Sozzi W, et al. Comparison of ultra-high versus conventional dose rate radiotherapy in a patient with cutaneous lymphoma. Radiother Oncol. 2022;174:87-91. doi:10.1016/j.radonc.2021.12.045
Mascia AE, Daugherty EC, Zhang Y, et al. Proton FLASH radiotherapy for the treatment of symptomatic bone metastases. JAMA Oncology. 2023;9(1):62. doi:10.1001/jamaoncol.2022.5843
Simeonov Y, Weber U, Schuy C, et al. Monte Carlo simulations and dose measurements of 2D range-modulators for scanned particle therapy. Zeitschrift Für Medizinische Physik. 2021;31(2):203-214. doi:10.1016/j.zemedi.2020.06.008
Arjomandy B, Taylor P, Ainsley C, et al. AAPM task group 224: comprehensive proton therapy machine quality assurance. Med Phys. 2019;46(8):e678-e705. doi:10.1002/mp.13622
Petersson K, Jaccard M, Germond JF, et al. High dose-per-pulse electron beam dosimetry -A model to correct for the ion recombination in the advanced markus ionization chamber. Med Phys. 2017;44(3):1157-1167. doi:10.1002/mp.12111
McManus M, Romano F, Lee ND, et al. The challenge of ionisation chamber dosimetry in ultra-short pulsed high dose-rate very high energy electron beams. Sci Rep. 2020;10(1). doi:10.1038/s41598-020-65819-y
Yang Y, Shi C, Chen C, et al. A 2D strip ionization chamber array with high spatiotemporal resolution for proton pencil beam scanning FLASH radiotherapy. Med Phys. 2022;49(8):5464-5475. doi:10.1002/mp.15706
Lee E, Lourenço AM, Speth J, et al. Ultrahigh dose rate pencil beam scanning proton dosimetry using ion chambers and a calorimeter in support of first in-human FLASH clinical trial. Med Phys. 2022;49(9):6171-6182. doi:10.1002/mp.15844
Verona Rinati G, Felici G, Galante F, et al. Application of a novel diamond detector for commissioning of FLASH radiotherapy electron beams. Med Phys. 2022;49(8):5513-5522. doi:10.1002/mp.15782
Marinelli M, Felici G, Galante F, et al. Design, realization, and characterization of a novel diamond detector prototype for FLASH radiotherapy dosimetry. Med Phys. 2022;49(3):1902-1910. doi:10.1002/mp.15473
Folkerts MM, Abel E, Busold S, Perez JR, Krishnamurthi V, Ling CC. A framework for defining FLASH dose rate for pencil beam scanning. Med Phys. 2020;47(12):6396-6404. doi:10.1002/mp.14456
Klein G. Performing a project premortem. Harv Bus Rev. 2007.
Pidikiti R, Patel BC, Maynard MR, et al. Commissioning of the world's first compact pencil-beam scanning proton therapy system. J Appl Clin Med Phys. 2018;19(1):94-105. doi:10.1002/acm2.12225
Darafsheh A, Hao Y, Zwart T, et al. Feasibility of proton FLASH irradiation using a synchrocyclotron for preclinical studies. Med Phys. 2020;47(9):4348-4355. doi:10.1002/mp.14253
Darafsheh A, Hao Y, Zhao X, et al. Spread-out Bragg peak proton FLASH irradiation using a clinical synchrocyclotron: proof of concept and ion chamber characterization. Med Phys. 2021;48(8):4472-4484. doi:10.1002/mp.15021
Andreo P, Burns DT, Hohlfeld K, et al. IAEA TRS-398: Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water. 2006.
Ding X, Zheng Y, Zeidan O, et al. A novel daily QA system for proton therapy. J Appl Clin Med Phys. 2013;14(2):115-126. doi:10.1120/jacmp.v14i2.4058
Yang Y, Kang M, Huang S, et al. Impact of respiratory motion on proton pencil beam scanning FLASH radiotherapy: an in silico and phantom measurement study. Phys Med Biol. 2023;68(8):085008. doi:10.1088/1361-6560/acc632
Kanouta E, Johansen JG, Kertzscher G, Sitarz MK, Sørensen BS, Poulsen PR. Time structure of pencil beam scanning proton FLASH beams measured with scintillator detectors and compared with log files. Med Phys. 2022;49(3):1932-1943. doi:10.1002/mp.15486