S1540
Interdisciplinary - Quality assurance and risk management
ESTRO 2026
oncology. Pact Radiat Oncol, 5(1), 32-35.3) Brundage, M.D., et al. (2017). Evidence-based guidance for peer review "best practices" in radiation oncology. J Clinic Oncol,35 (8 suppl), 180. Keywords: Peer review, Quality improvement
Poster Discussion 4925
Multinational harmonization and reciprocity of radiotherapy clinical trial dosimetry credentialing; reducing barriers to global trial participation Stephen Kry 1 , Jessica Lye 2 , Brooks Fre'Etta 2 , Hussein Mohammad 3 , Christine Peterson 4 , Mitsuhiro Nakamura 5 , Mallory Glenn 1 , Patricia Diez 6 , Rushil Patel 6 , Peter Greer 7 , Rhonda Brown 8 , Hideaki Hirashima 5 , Joerg Lehmann 9 , Catharine H Clark 10 1 Radiation Physics, MD Anderson, Houston, USA. 2 Radiation Oncology, Austin Health, Melbourne, Australia. 3 Radiation Oncology, King Khalid University Medical City, Abha Asir, Saudi Arabia. 4 Biostatistics, MD Anderson, Houston, USA. 5 JCOG division of medical physics, Kyoto University, Kyoto, Japan. 6 RTTQA, RTTQA, Northwood, United Kingdom. 7 Radiation Oncology, University of Newcastle, Newcastle, Australia. 8 Australian Clinical Dosimetry Services, ARPANSA, Yallambie, Australia. 9 Radiation Oncology, Calvary Mater Hospital, Newcastle, Australia. 10 Department of Radiological Physics, University College of London, London, United Kingdom Purpose/Objective: To reduce participation barriers in multi-national clinical trials by harmonising dosimetry credentialing standards. Presently, institutions participating in clinical trials from different countries must undergo separate dosimetry audits for each country’s clinical trial, leading to inefficiencies and redundancies that discourage participation in such multi-national trials. Establishing reciprocity agreements among different credentialing programs will remove this redundancy and streamline participation while still ensuring high quality data. Material/Methods: Independently developed radiotherapy dosimetry audit systems based in North America (IROC) Australia/New Zealand (TROG /ACDS) and the UK (RTTQA/NPL) were evaluated on 144 intensity modulated treatment plans with purposely introduced errors of varying degrees to assess their ability to detect clinically impactful errors (defined as mean target dose differences of 3%, 5%, or 7%). Sensitivity (unacceptable plan detection) and specificity (correctly identifying acceptable plans) were evaluated using credentialing criteria currently employed, along with receiver operating characteristic (ROC) analysis. The credentialing tolerances were then tuned to achieve 95% sensitivity; this was chosen to be a universally acceptable credentialing performance and therefore served as a basis for credentialing reciprocity between regions. Results: When evaluated according to current credentialing
Digital Poster Highlight 4916
Treatment Compliance in Modern Clinical Trials Jessica R Lowenstein, Hannah Nguyen, Stephen F Kry Radiation Physics, MD Anderson Cancer Center, Houston, USA Purpose/Objective: IROC Houston provides assurance to the National Cancer Institute (NCI) that participating institutions deliver radiation doses that are clinically comparable and consistent across sites. This study reviewed the past decade of treatment reviews to understand the prevalence of deviations from protocols. Material/Methods: Case reviews included dosimetric evaluations and contour evaluations of target and organ-at-risk volumes. Pre-treatment reviews occurred prior to treatment initiation, whereas retrospective reviews are performed post-treatment. Deviations were categorized as minor or major deviations according to protocol specifications. Deviation rates from 2015 – 2025 were abstracted from 9 different trials, totaling 2319 cases, that were active during this period. Rates were compared over time, as was the impact of pre- treatment reviews on subsequent compliance. Results: Over the last decade pre-treatment reviews identified major and minor deviations in 16% and 33% of cases, respectively. From 2015–2019, major and minor deviation rates were 14.5% and 28.3%, whereas from 2020–2025, rates increased to 39.2% and 26.8%. The observed increase in major deviations likely reflects the growing complexity of protocols and patient treatments. In a subset of 157 institutions that underwent both pre-treatment and retrospective reviews for the same protocol, pre-treatment reviews revealed major and minor deviations of 6% and 58%; subsequent patient submissions with retrospective evaluations showed improved compliance with major and minor deviation rates reduced to 3% and 20%. Conclusion: Case reviews continue to identify a substantial fraction of patients not treated per protocol, reinforcing the importance of QA intervention. Pre-treatment case reviews are an effective tool for identifying problems with protocol compliance and educating practitioners
so that future deviation rates are reduced. Keywords: Quality Assurance, Clinical Trials
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