2229 - National Institute Position on the Commissioning and Quality Assurance of Proton Therapy Facilities
Presenter(s)
A. Santos1,2, S. Penfold1,3, M. Douglass1,2, U. Jelen4, J. Yap5, P. Wilson2,6, A. Fielding7,8, S. Peet9,10, E. Smith11, and J. Sykes12,13; 1Australian Bragg Centre for Proton Therapy and Research, Adelaide, SA, Australia, 2Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia, 3School of Physics, Chemistry and Earth Sciences, University of Adelaide, Adelaide, SA, Australia, 4GenesisCare St. Vincent's Clinic, Sydney, NSW, Australia, 5School of Physics, University of Melbourne, Melbourne, Australia, 6Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia, 7School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia, 8Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD, Australia, 9Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia, 10School of Electrical Engineering and Computer Science, University of Queensland, Brisbane, QLD, Australia, 11GenesisCare, Melbourne, VIC, Australia, 12Sydney West Radiation Oncology Network, Sydney, NSW, Australia, 13Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
Purpose/Objective(s):
The commissioning and quality assurance (QA) of proton therapy (PBT) facilities present unique challenges compared to conventional photon-based radiotherapy. Due to differences in beam properties, treatment delivery, and limited global experience, a robust, risk-based QA framework is essential. This position paper, developed by the Particle Therapy Working Group (PTWG) of a national institute for medical physics, states that adopting standardized QA protocols and international guidelines will improve treatment accuracy, patient safety, and long-term clinical outcomes in PBT centres.Materials/Methods:
A review of current international commissioning and QA standards, including AAPM TG-185 (commissioning), AAPM TG-224 (machine QA), and IAEA TRS-398 (reference dosimetry), was conducted. Risk-based methodologies such as Failure Modes and Effects Analysis (FMEA) were evaluated for implementation. Training requirements, independent audits, and specialized considerations for treatment planning, patient-specific QA, and emerging techniques such as proton arc therapy and FLASH therapy were assessed.Results:
The PTWG endorses international standards for PBT commissioning and QA while emphasizing the need for site-specific customization based on equipment and workflow. Key recommendations include: (1) multimodal training for staff, (2) robust machine QA covering beam delivery, image guidance, and safety systems, (3) comprehensive treatment planning system commissioning, and (4) patient-specific QA strategies integrating independent dose verification and log file analysis. Emerging techniques, including adaptive therapy and respiratory motion management, require tailored QA approaches.Conclusion:
Implementing standardized, risk-based QA programs for PBT facilities will enhance treatment accuracy, patient safety, and clinical efficiency. As Australia establishes their first PBT centres, these guidelines serve as a foundational framework for ensuring compliance with international best practices. Future research should focus on refining QA protocols for novel PBT technologies and adaptive treatment strategies.