Submitted by Neil McColl, Public Health England - CRCE Commenting on behalf of the organisation
Line 472 It might be helpful to reflect that accurate patient localisation and set-up are also key components of successful treatment.
Line 620 Consideration could be given to noting that “immobilisation must be sufficiently robust to maintain its integrity for the duration of treatment and fully support a reproducible patient treatment position.”
Line 647 This section could usefully comment further on the frequency of use of verification imaging to ensure geometric match of treatment.
Line 2612 Consideration could be given to adding an expectation that “all imaging procedures associated with ion treatment delivery should be justified in advance of initiation of the exposure with an appreciation of the expected cumulative dose for each individual patient.”
Conclusions and Recommendations. These should reflect the need for: prior risk assessment of all elements of the patient pathway; that there is timely retrospective analysis of accidental and potential accidental exposures; and that lessons learnt such events are incorporated into practice.
General The document would benefit from inclusion of recommendations around on-treatment review and long-term follow up and management of side-effects. This might be especially important in identifying unexpected side-effects associated with accidental exposures.