Radiation therapy quality assurance in clinical trials – Global harmonisation group

Melidis, Christos; Bosch, Walter; Iżewska, J.; Fidarova, Elena; Zubizarreta, Eduardo; Ishikura, Satoshi; Followill, David S; Galvin, James M.; Xiao, Ying; Ebert, Martin A.; Kron, Tomas; Clark, Catharine H.; Miles, Elizabeth; Aird, Edwin; Weber, Damien Charles; Ulin, Kenneth; Verellen, Dirk; Hurkmans, Coen

doi:10.1016/j.radonc.2014.03.023

Cited by 57 publications

(38 citation statements)

References 30 publications

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“…The goals are to collate, homogenize and distribute information regarding the radiotherapy quality assurance standards across audit groups, provide a platform for prospective discussions on new audit procedures, software tools, guidelines and policies and provide a framework to endorse existing and future audit procedures and guidelines across various trial groups. 58 Recent work 59 has included harmonizing the nomenclature for volume naming across international trials.…”

Section: International Links and Harmonizationmentioning

confidence: 99%

“…The main contributors are currently the NPL, RTTQA and the IPEM interdepartmental audit groups; however, there are also links with other international groups such as the ACDS, TROG, EORTC and IROC. On an international level, the Global Harmonisation Group now meets regularly and several co-ordinated projects have been completed 58,59 or are under way.…”

Section: Recent Developments In Auditmentioning

confidence: 99%

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Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Clark

Aird

Bolton

et al. 2015

BJR

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Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

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Section: International Links and Harmonizationmentioning

confidence: 99%

Section: Recent Developments In Auditmentioning

confidence: 99%

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Clark

Aird

Bolton

et al. 2015

BJR

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“…This RTQA process is in essence a verification of the dose delivery under reference conditions at the accruing site and defines, with the facility questionnaire the RTQA Level 1 [3]. It is a dose measurement performed by a national or international auditor, independent from the site, and the results are fed back to EORTC headquarters [4]. Published BOA data measured by an independent body and collected in the perspective of a trial coordination organization is scarce.…”

Section: Introductionmentioning

confidence: 99%

Beam Output Audit results within the EORTC Radiation Oncology Group network

et al. 2016

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Beam Output Auditing (BOA) is one key process of the EORTC radiation therapy quality assurance program. Here the results obtained between 2005 and 2014 are presented and compared to previous results.For all BOA reports the following parameters were scored: centre, country, date of audit, beam energies and treatment machines audited, auditing organisation, percentage of agreement between stated and measured dose.Four-hundred and sixty-one BOA reports were analyzed containing the results of 1790 photon and 1366 electron beams, delivered by 755 different treatment machines. The majority of beams (91.1%) were within the optimal limit of ≤ 3%. Only 13 beams (0.4%; n = 9 electrons; n = 4 photons), were out of the range of acceptance of ≤ 5%. Previous reviews reported a much higher percentage of 2.5% or more of the BOAs with >5% deviation.The majority of EORTC centres present beam output variations within the 3% tolerance cutoff value and only 0.4% of audited beams presented with variations of more than 5%. This is an important improvement compared to previous BOA results.

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“…1 An important feature of RTQA is acknowledgment of not only the inherent complexity associated with the radiotherapy pathway, but also the varying technical and practical aspects across different departments.…”

Section: Introductionmentioning

confidence: 99%

Dose specification for hippocampal sparing whole brain radiotherapy (HS WBRT): considerations from the UK HIPPO trial QA programme

Megias

Phillips

Clifton‐Hadley

et al. 2017

The British Journal of Radiology

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Objective: The HIPPO trial is a UK randomized Phase II trial of hippocampal sparing (HS) vs conventional wholebrain radiotherapy after surgical resection or radiosurgery in patients with favourable prognosis with 1-4 brain metastases. Each participating centre completed a planning benchmark case as part of the dedicated radiotherapy trials quality assurance programme (RTQA), promoting the safe and effective delivery of HS intensity-modulated radiotherapy (IMRT) in a multicentre trial setting. Methods: Submitted planning benchmark cases were reviewed using visualization for radiotherapy software (VODCA) evaluating plan quality and compliance in relation to the HIPPO radiotherapy planning and delivery guidelines. Results: Comparison of the planning benchmark data highlighted a plan specified using dose to medium as an outlier by comparison with those specified using dose to water. Further evaluation identified that the reported plan statistics for dose to medium were lower as a result of the dose calculated at regions of PTV inclusive of bony cranium being lower relative to brain. Conclusion: Specification of dose to water or medium remains a source of potential ambiguity and it is essential that as part of a multicentre trial, consideration is given to reported differences, particularly in the presence of bone. Evaluation of planning benchmark data as part of an RTQA programme has highlighted an important feature of HS IMRT dosimetry dependent on dose being specified to water or medium, informing the development and undertaking of HS IMRT as part of the HIPPO trial. Advances in knowledge: The potential clinical impact of differences between dose to medium and dose to water are demonstrated for the first time, in the setting of HS whole-brain radiotherapy.

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Radiation therapy quality assurance in clinical trials – Global harmonisation group

Cited by 57 publications

References 30 publications

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Beam Output Audit results within the EORTC Radiation Oncology Group network

Dose specification for hippocampal sparing whole brain radiotherapy (HS WBRT): considerations from the UK HIPPO trial QA programme

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