The University of Texas, MD Anderson Cancer Center, Houston, Texas.
The University of Texas, MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2022 Mar 15;112(4):1004-1011. doi: 10.1016/j.ijrobp.2021.10.145. Epub 2021 Nov 13.
This study aimed to highlight the value and key findings of on-site proton audits.
The authors performed 38 on-site measurement-based peer reviews of proton centers participating in National Cancer Institute-funded clinical trials. The reviews covered beam calibration, lateral and depth measurements, mechanical checks, treatment planning and clinical practice, and quality assurance (QA) practices. Program deficiencies were noted, and recommendations were made about ways institutions could improve their practices.
Institutions received an average of 3 (range, 1-8) recommendations for practice improvements. The number of deficiencies did not decrease over time, highlighting the continued need for this type of peer review. The most common deficiencies were for Task Group-recommended QA compliance (97% of centers), computed tomography number (CTN) to relative linear stopping power conversion (59%), and QA procedures (53%). In addition, 32% of institutions assessed failed at least 1 lateral beam profile measurement (<90% of pixels passing 3% [global]/3 mm; 10% threshold), despite passing internal QA measurements. These failures occurred for several different plan configurations (large, small, shallow, and deep targets) and at different depths in the beam path (proximal to target, central, and distal). CTN to relative linear stopping power conversion curves showed deviations at low, mid, and high CTNs and highlighted areas of inconsistency between proton centers, with many centers falling outside of 2 sigma of the mean curve of their peers. All deficiencies from the peer review were discussed with the institutions, and many implemented dosimetric treatment planning and practice changes to improve the accuracy of their system and consistency with other institutions.
This peer review program has been integral in confirming and promoting consistency and best practice across proton centers for clinical trials, minimizing deviations for outcomes data.
本研究旨在强调现场质子审核的价值和主要发现。
作者对参与美国国立癌症研究所资助的临床试验的质子中心进行了 38 次基于现场测量的同行评审。这些评审涵盖了束校准、横向和深度测量、机械检查、治疗计划和临床实践以及质量保证（QA）实践。记录了项目缺陷，并就机构如何改进其实践提出了建议。
各机构平均收到 3（范围为 1-8）项实践改进建议。随着时间的推移，缺陷数量并没有减少，这突出表明需要持续进行这种类型的同行评审。最常见的缺陷是针对工作组推荐的 QA 合规性（97%的中心）、计算的 CT 数到相对线性阻止功率转换（59%）和 QA 程序（53%）。此外，尽管通过了内部 QA 测量，但仍有 32%的机构未能通过至少 1 个横向束轮廓测量（<90%的像素通过 3%[全局]/3mm；10%的阈值）。这些失败发生在几个不同的计划配置（大、小、浅和深目标）和束路径的不同深度（靠近目标、中心和远端）。CT 数到相对线性阻止功率转换曲线显示在低、中、高 CTN 处存在偏差，并突出了质子中心之间的不一致区域，许多中心偏离了同行平均曲线的 2 个标准差。与机构讨论了同行评审中的所有缺陷，许多机构实施了剂量学治疗计划和实践变更，以提高系统的准确性并与其他机构保持一致。
该同行评审计划对于在临床试验中确认和促进质子中心之间的一致性和最佳实践至关重要，最大限度地减少了结果数据的偏差。
