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FitzGerald TJ, Bishop-Jodoin M, Laurie F, Iandoli M, Smith K, Ulin K, Ding L, Moni J, Cicchetti MG, Knopp M, Kry S, Xiao Y, Rosen M, Prior F, Saltz J, Michalski J. The Importance of Quality Assurance in Radiation Oncology Clinical Trials. Semin Radiat Oncol 2023; 33:395-406. [PMID: 37684069 DOI: 10.1016/j.semradonc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Clinical trials have been the center of progress in modern medicine. In oncology, we are fortunate to have a structure in place through the National Clinical Trials Network (NCTN). The NCTN provides the infrastructure and a forum for scientific discussion to develop clinical concepts for trial design. The NCTN also provides a network group structure to administer trials for successful trial management and outcome analyses. There are many important aspects to trial design and conduct. Modern trials need to ensure appropriate trial conduct and secure data management processes. Of equal importance is the quality assurance of a clinical trial. If progress is to be made in oncology clinical medicine, investigators and patient care providers of service need to feel secure that trial data is complete, accurate, and well-controlled in order to be confident in trial analysis and move trial outcome results into daily practice. As our technology has matured, so has our need to apply technology in a uniform manner for appropriate interpretation of trial outcomes. In this article, we review the importance of quality assurance in clinical trials involving radiation therapy. We will include important aspects of institution and investigator credentialing for participation as well as ongoing processes to ensure that each trial is being managed in a compliant manner. We will provide examples of the importance of complete datasets to ensure study interpretation. We will describe how successful strategies for quality assurance in the past will support new initiatives moving forward.
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Affiliation(s)
- Thomas J FitzGerald
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA..
| | | | - Fran Laurie
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Matthew Iandoli
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Koren Smith
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Kenneth Ulin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Linda Ding
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Janaki Moni
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - M Giulia Cicchetti
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA
| | - Michael Knopp
- Department of Radiology, University of Cincinnati, Cincinnati, OH
| | - Stephen Kry
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mark Rosen
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University in St Louis, St Louis, MO
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Ding L, Bradford C, Kuo IL, Fan Y, Ulin K, Khalifeh A, Yu S, Liu F, Saleeby J, Bushe H, Smith K, Bianciu C, LaRosa S, Prior F, Saltz J, Sharma A, Smyczynski M, Bishop-Jodoin M, Laurie F, Iandoli M, Moni J, Cicchetti MG, FitzGerald TJ. Radiation Oncology: Future Vision for Quality Assurance and Data Management in Clinical Trials and Translational Science. Front Oncol 2022; 12:931294. [PMID: 36033446 PMCID: PMC9399423 DOI: 10.3389/fonc.2022.931294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The future of radiation oncology is exceptionally strong as we are increasingly involved in nearly all oncology disease sites due to extraordinary advances in radiation oncology treatment management platforms and improvements in treatment execution. Due to our technology and consistent accuracy, compressed radiation oncology treatment strategies are becoming more commonplace secondary to our ability to successfully treat tumor targets with increased normal tissue avoidance. In many disease sites including the central nervous system, pulmonary parenchyma, liver, and other areas, our service is redefining the standards of care. Targeting of disease has improved due to advances in tumor imaging and application of integrated imaging datasets into sophisticated planning systems which can optimize volume driven plans created by talented personnel. Treatment times have significantly decreased due to volume driven arc therapy and positioning is secured by real time imaging and optical tracking. Normal tissue exclusion has permitted compressed treatment schedules making treatment more convenient for the patient. These changes require additional study to further optimize care. Because data exchange worldwide have evolved through digital platforms and prisms, images and radiation datasets worldwide can be shared/reviewed on a same day basis using established de-identification and anonymization methods. Data storage post-trial completion can co-exist with digital pathomic and radiomic information in a single database coupled with patient specific outcome information and serve to move our translational science forward with nimble query elements and artificial intelligence to ask better questions of the data we collect and collate. This will be important moving forward to validate our process improvements at an enterprise level and support our science. We have to be thorough and complete in our data acquisition processes, however if we remain disciplined in our data management plan, our field can grow further and become more successful generating new standards of care from validated datasets.
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Affiliation(s)
- Linda Ding
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Carla Bradford
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - I-Lin Kuo
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Yankhua Fan
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Kenneth Ulin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Abdulnasser Khalifeh
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Suhong Yu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fenghong Liu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Jonathan Saleeby
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Harry Bushe
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Koren Smith
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Camelia Bianciu
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Salvatore LaRosa
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas, Little Rock, AR, United States
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University, Atlanta, GA, United States
| | - Mark Smyczynski
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Maryann Bishop-Jodoin
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Fran Laurie
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Matthew Iandoli
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Janaki Moni
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - M. Giulia Cicchetti
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
| | - Thomas J. FitzGerald
- Department of Radiation Oncology, UMass Chan Medical School, Worcester, MA, United States
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Dietzsch S, Braesigk A, Seidel C, Remmele J, Kitzing R, Schlender T, Mynarek M, Geismar D, Jablonska K, Schwarz R, Pazos M, Walser M, Frick S, Gurtner K, Matuschek C, Harrabi SB, Glück A, Lewitzki V, Dieckmann K, Benesch M, Gerber NU, Rutkowski S, Timmermann B, Kortmann RD. Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma : First experiences of the German radiotherapy quality control panel in the SIOP PNET5 MB trial. Strahlenther Onkol 2020; 197:674-682. [PMID: 33226469 PMCID: PMC8292275 DOI: 10.1007/s00066-020-01707-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022]
Abstract
Purpose Several studies have demonstrated the negative impact of radiotherapy protocol deviations on tumor control in medulloblastoma. In the SIOP PNET5 MB trial, a pretreatment radiotherapy quality control (RT-QC) program was introduced. A first analysis for patients enrolled in Germany, Switzerland and Austria with focus on types of deviations in the initial plan proposals and review criteria for modern radiation technologies was performed. Methods and patients Sixty-nine craniospinal irradiation (CSI) plans were available for detailed analyses. RT-QC was performed according to protocol definitions on dose uniformity. Because of the lack of definitions for high-precision 3D conformal radiotherapy within the protocol, additional criteria for RT-QC on delineation and coverage of clinical target volume (CTV) and planning target volume (PTV) were defined and evaluated. Results Target volume (CTV/PTV) deviations occurred in 49.3% of initial CSI plan proposals (33.3% minor, 15.9% major). Dose uniformity deviations were less frequent (43.5%). Modification of the RT plan was recommended in 43.5% of CSI plans. Unacceptable RT plans were predominantly related to incorrect target delineation rather than dose uniformity. Unacceptable plans were negatively correlated to the number of enrolled patients per institution with a cutoff of 5 patients (p = 0.001). Conclusion This prospective pretreatment individual case review study revealed a high rate of deviations and emphasizes the strong need of pretreatment RT-QC in clinical trials for medulloblastoma. Furthermore, the experiences point out the necessity of new RT-QC criteria for high-precision CSI techniques. Electronic supplementary material The online version of this article (10.1007/s00066-020-01707-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Dietzsch
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany.
| | - Annett Braesigk
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Clemens Seidel
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Julia Remmele
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Ralf Kitzing
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Tina Schlender
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
| | - Martin Mynarek
- Departement of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Geismar
- Clinic for Particle Therapy, West German Proton Therapy Centre, University of Essen, Essen, Germany
| | - Karolina Jablonska
- Faculty of Medicine, Department of Radiation Oncology, University of Cologne, Cologne, Germany
| | - Rudolf Schwarz
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Montserrat Pazos
- Department of Radiotherapy and Radiation Oncology, Ludwig Maximilian University Munich, Munich, Germany
| | - Marc Walser
- Center for Protontherapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Silke Frick
- Department of Radiotherapy and Radiation Oncology, Hospital Bremen Mitte, Bremen, Germany
| | - Kristin Gurtner
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Semi Ben Harrabi
- Department of Radiation Oncology and Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - Albrecht Glück
- Radiation Oncology, Munich-Schwabing Municipal Hospital, Munich, Germany
| | - Victor Lewitzki
- Department of Radiotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Martin Benesch
- Division of Pediatric Hematology/Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Stefan Rutkowski
- Departement of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Therapy Centre, University of Essen, Essen, Germany
| | - Rolf-Dieter Kortmann
- Department for Radiation Oncology, University of Leipzig Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
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Potential Role of the Quality Assurance Review Center Platform in Global Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 99:956-962. [PMID: 29063855 DOI: 10.1016/j.ijrobp.2017.06.2461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
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Gwynne S, Jones G, Maggs R, Eaton D, Miles E, Staffurth J, Nixon L, Ray R, Lewis G, Crosby T, Spezi E. Prospective review of radiotherapy trials through implementation of standardized multicentre workflow and IT infrastructure. Br J Radiol 2016; 89:20160020. [PMID: 27245136 PMCID: PMC5124880 DOI: 10.1259/bjr.20160020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/03/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE: We sought to develop a process that would allow us to perform a prospective review of outlining in trials using expert reviewers based in multiple centres. METHODS: We implemented a specific information technology infrastructure and workflow that could serve all organizations involved in the radiotherapy quality assurance (RTQA) process. RESULTS: Data were processed and packaged in the computational environment for radiotherapy research (CERR) binary format and securely transmitted to the expert reviewer at the designated remote organization. It was opened and reviewed using the distributed CERR-compiled application, and a standardized report was sent to the respective centre. Centres were expected to correct any unacceptable deviations and resubmit outlining for approval prior to commencing treatment. 75% of reviews were completed and fed back to centres within 3 working days. There were no delays in treatment start date. CONCLUSION: Our distributed RTQA review approach provides a method of prospective outlining review at multiple centres, without compromising the quality, delaying the start of treatment or the need for significant additional infrastructure resources. Future progress in the area of prospective individual case review will need to be supported by additional resources for clinician time to undertake the reviews. ADVANCES IN KNOWLEDGE: Trial groups around the world have formulated different approaches to address the need for the prospective review of radiotherapy (RT) data with clinical trials, in line with available resources. We report a UK solution that has allowed the workload for outlining review to be distributed across a wider group of volunteer reviewers without the need for any additional infrastructure costs and has already been adopted within the UK RT trials community.
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Affiliation(s)
- Sarah Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
| | - Gareth Jones
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | - Rhydian Maggs
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | - David Eaton
- Radiotherapy Physics, Mount Vernon Hospital, Northwood, UK
- NCRI RTTQA Team, Mount Vernon Hospital, Northwood, UK
| | | | - John Staffurth
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Lisette Nixon
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
| | - Ruby Ray
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Geraint Lewis
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | | | - Emiliano Spezi
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- School of Engineering, Cardiff University, Cardiff, UK
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Gong YUT, Yu J, Pang D, Zhen H, Galvin J, Xiao Y. Automated Extraction of Dose/Volume Statistics for Radiotherapy-Treatment-Plan Evaluation in Clinical-Trial Quality Assurance. Front Oncol 2016; 6:47. [PMID: 26973814 PMCID: PMC4776636 DOI: 10.3389/fonc.2016.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/16/2016] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy clinical-trial quality assurance is a crucial yet challenging process. This note presents a tool that automatically extracts dose/volume statistics for determining dosimetry compliance review with improved efficiency and accuracy. A major objective of this study is to develop an automated solution for clinical-trial radiotherapy dosimetry review.
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Affiliation(s)
| | - Jialu Yu
- IROC, Philadelphia, PA, USA; Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Dalong Pang
- Department of Radiation Medicine, Georgetown University Hospital , Washington, DC , USA
| | - Heming Zhen
- Rush University Medical Center , Chicago, IL , USA
| | | | - Ying Xiao
- IROC, Philadelphia, PA, USA; Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Structures' validation profiles in Transmission of Imaging and Data (TRIAD) for automated National Clinical Trials Network (NCTN) clinical trial digital data quality assurance. Pract Radiat Oncol 2016; 6:331-333. [PMID: 27053498 DOI: 10.1016/j.prro.2016.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
Transmission of Imaging and Data (TRIAD) is a standard-based system built by the American College of Radiology to provide the seamless exchange of images and data for accreditation of clinical trials and registries. Scripts of structures' names validation profiles created in TRIAD are used in the automated submission process. It is essential for users to understand the logistics of these scripts for successful submission of radiation therapy cases with less iteration.
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Radiation therapy digital data submission process for national clinical trials network. Int J Radiat Oncol Biol Phys 2014; 90:466-7. [PMID: 25304799 DOI: 10.1016/j.ijrobp.2014.05.2672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 11/22/2022]
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