The well-defined range of a particle therapy beam may allow users to create a more targeted radiation dose distribution than is possible from an x-ray beam, but careful application of particle beams requires consideration of several uncertainties that are relatively trivial in photon therapy. This presentation describes some of the chief differences between particle therapy and x-ray treatments, including robust optimization, consideration of tumor depth during image guidance, off-line plan verification and adaptation, and attention to biologic dose. Some emerging trends in particle therapy is also discussed, such as the development of online adaptive proton therapy and progress toward the first heavy ion therapy facility in the United States.

Quality assurance is crucial for new and rapidly evolving technologies, such as proton and heavy ion radiation therapy, which require accurate application to be effective.

In this session, the critical role of peer review audits in particle therapy is demonstrated, underscoring their importance in ensuring the accuracy and safety of cancer treatments. Peer review audits serve as a vital checkpoint, catching potential errors in treatment planning and delivery that could otherwise compromise patient (and clinical trial) outcomes. Several real-world examples of particle therapy treatment planning and delivery errors identified through peer review audits is presented, illustrating the types of issues that can arise and the impact of these audits in catching and correcting them. Additionally, practical techniques for rectifying such errors is shared, providing valuable insights for practitioners.