R.T. Quality Assurance Robert Lustig, MD Robert Lustig, MD James Galvin, D.Sc., RTOG Group Physicist James Galvin, D.Sc., RTOG Group Physicist Ying Xiao, Ph.D., RTOG Core Lab Physicist Ying Xiao, Ph.D., RTOG Core Lab Physicist Betty O’Meara, Director Betty O’Meara, Director Denise Manfredi, Senior Dosimetrist, Brain and CCOP Denise Manfredi, Senior Dosimetrist, Brain and CCOP Julie McIlvaine, Lung Julie McIlvaine, Lung Nancy Linnemann, H/N and Sarcoma Nancy Linnemann, H/N and Sarcoma Jennifer Presley, GU Jennifer Presley, GU Joanne Hunter, Multiple Disease Sites Joanne Hunter, Multiple Disease Sites Sue McNulty, GI, GYN and Breast Sue McNulty, GI, GYN and Breast Tammy McGlade, Administrative Assistant Tammy McGlade, Administrative Assistant Erin Cunningham, Project Specialist Erin Cunningham, Project Specialist

R.T. Quality Assurance The RTQA staff is responsible for coordinating the review process for the radiation treatments delivered on protocol studies. We have two methods of reviews. The RTQA staff is responsible for coordinating the review process for the radiation treatments delivered on protocol studies. We have two methods of reviews. Studies that are submitted to HQ are reviewed on film and paper Studies that are submitted to HQ are reviewed on film and paper Studies that are submitted to ITC are reviewed using a remote review tool Studies that are submitted to ITC are reviewed using a remote review tool

Preliminary Data Studies submitted to HQ (with an initial review) Data to be submitted to RTQA Dept. within one week of start of radiation treatment: Data to be submitted to RTQA Dept. within one week of start of radiation treatment: T2- Protocol treatment form T2- Protocol treatment form T3 Initial Simulation/DRR’s & Portal Images T3 Initial Simulation/DRR’s & Portal Images T4 Computer generated dose calculation data T4 Computer generated dose calculation data Please see examples in RTQA Orientation Booklet Please see examples in RTQA Orientation Booklet

Z2 Memorandum The Z2 is a request for additional initial dosimetry information. This request is generated after the radiation oncologist has reviewed the case and determines that additional data is necessary to complete the initial review process. When sending additional dosimetry data attach a copy of Z2 form to ensure calendar credit.

Initial review: “Deviation” Memorandum (Blue ) A variation in the RT data submitted (Yellow) A variation was found, but too late to if changes are made new data needs to make changes to treatment to be submitted with this form Still submit the final RT data

Preliminary Data Studies submitted to HQ (without an initial review) See Section 12.1 See Section 12.1 Brain studies require the Pre & Post-surgery scans and reports submitted within 1 week of RT

Final Data studies submitted to HQ Due within one week of completion of Radiation Treatment: o T1- Radiotherapy Form (web data enter) o F4 - Radiotherapy Form (web data enter) o T5- RT Treatment Record/Daily Chart o T6- Summated isodose distribution (in color) o TP- Simulation or DRR’s & Portal images of all fields treated o TL- Computer dose calculation data o DV- Dose Volume Histogram (in color) o T8 Simulation or DRR’s & Portal images of all boost fields (This code is o nly for studies with an Initial review) o SR- Radiology Review Form (web data enter)

T1/F4 Radiotherapy Form T1/F4 form is web entered after RT has been completed. ITC will receive a copy automatically Total dose must reflect exact amount of radiation patient received A T1 must be completed on every case even when RT not given Definition of Elapsed Days: From the 1 st tx thru last counting any days off

T5 Copy of patient’s Daily Treatment chart – The T5 is NOT A FORM Record of Radiation Treatment from first to last day Information includes field identifications, treatment dates, treatment times if applicable for BID, daily and total doses

T6 Color Isodose Distribution

TP DRR’s or Simulation & port film or portal image of each Initial field must be submitted either on hard film or paper DRR of an Initial field DRR of an Initial field Portal Image of an Initial field

TP DRR’s or simulation & port film or portal image of each Boost field must be submitted either on hard film or paper DRR of a boost field DRR of a boost field Portal image of a boost field

TL Computer generated dose calculation data

DV ( Dose Volume Histogram) This must be submitted in color

Submitting the data to HQ If you submit multiple cases together, they must be separated from each other with clips If you submit multiple cases together, they must be separated from each other with clips Please do not staple different coded data together Please do not staple different coded data together Put a label on each film, each paper. Do not put label over field name Put a label on each film, each paper. Do not put label over field name Label template available on our website Label template available on our website

Dosimetry Transmittal Form The Dosimetry transmittal form should be used when RT data is sent to HQ. This does not replace identifying films/papers with the appropriate labels. Also submit this form to suppress RT data

Z4 Query Form from HQ RTQA form requesting additional data to complete preparation for final review by Study Chair Requires a prompt response

Digital Information to HQ RTOG 0834 RTOG Dosimetry Data Submission 6.3Dosimetry Data Submission Submit the following digital data to RTOG Headquarters via the RTOG website: Submit the following digital data to RTOG Headquarters via the RTOG website: Due within 2 weeks of RT completion Pre-op & post-op scans (C1) Must be digitally submitted in DICOM format. See for directions. DRRs and portal images of each field (TP) must be digitally submitted in JPEG/DICOM format. Due within 2 weeks of RT completion Pre-op & post-op scans (C1) Must be digitally submitted in DICOM format. See for directions. DRRs and portal images of each field (TP) must be digitally submitted in JPEG/DICOM format. Newer specific studies may request selected digital information (DRRs, CTs, and MRIs) be submitted to a SFTP account or sent on a CD.

RT QA Page on Website

R.T. Quality Assurance Final Review (Studies submitted to HQ) Study Chair evaluation of entire course of Radiation Therapy after all required data has been received at Headquarters Study Chair evaluation of entire course of Radiation Therapy after all required data has been received at Headquarters Determine if each patient’s treatment was delivered according to protocol Determine if each patient’s treatment was delivered according to protocol Scores are given for total dose delivered, field borders, dose fractionation, and total elapsed days of treatment Scores are given for total dose delivered, field borders, dose fractionation, and total elapsed days of treatment

Studies submitted to ITC Section 12.2 – are your guidelines for submission New studies will have a code on the calendar (DD) for all initial digital data submission to ITC New studies require a copy of the T5 to HQ & ITC T1/F4 form is web data entered (copy is automatically sent to ITC)

Dosimetry Transmittal Form ( Studies submitted to ITC) The Transmittal form should be used when RT data is sent to ITC and HQ Submit to ITC and HQ to suppress RT data

Z4 A query form from HQ for studies submitted to ITC RTQA staff at HQ will send queries for data ITC must be contacted for specific details if you receive one of these requests

R.T. Quality Assurance Final Review (Studies submitted to ITC) ITC notifies RTQA at HQ when cases have passed the data integrity thus ready for review by the PI ITC notifies RTQA at HQ when cases have passed the data integrity thus ready for review by the PI We initiate the final review process by the PI We initiate the final review process by the PI Some studies have a rapid review of an institutions 1 st case. A patient cannot be treated until the site receives feedback from the reviewer of the study. Some studies have a rapid review of an institutions 1 st case. A patient cannot be treated until the site receives feedback from the reviewer of the study.

Rapid Reviews Require 3 business days for review process Require 3 business days for review process 0813 (lung) – 0813 (lung) – Rapid review on first patient Rapid review on first patient T5 must be faxed on last day of treatment to HQ ( ) T5 must be faxed on last day of treatment to HQ ( ) If patient does not complete treatment dose assigned, RTOG HQ must be notified. Call Tammy McGlade ( ) If patient does not complete treatment dose assigned, RTOG HQ must be notified. Call Tammy McGlade ( ) 0915 (lung) (lung)- First case enrolled on each arm requires a rapid review First case enrolled on each arm requires a rapid review

Rapid Reviews 0848 (pancreas) For Arm 4 only: 0848 (pancreas) For Arm 4 only: Every case is a rapid review Every case is a rapid review Digital data must be submitted within 14 – 21 days after 2nd step registration to allow ample time for possible replanning and resubmission of data Digital data must be submitted within 14 – 21 days after 2nd step registration to allow ample time for possible replanning and resubmission of data Optional submission of pretreatment scan through an SFTP site (directions in sect. 12) Optional submission of pretreatment scan through an SFTP site (directions in sect. 12) 0631 (SBRT Spine) 0631 (SBRT Spine) First case is a rapid review First case is a rapid review

Rapid Reviews 0724 (Cervix) 0724 (Cervix) For Each Treatment Modality Option: For Each Treatment Modality Option: First case is a Rapid Review First case is a Rapid Review Next four cases are a Timely Review (RT can start but data is to be submitted immediately; feedback will then be provided if necessary) Next four cases are a Timely Review (RT can start but data is to be submitted immediately; feedback will then be provided if necessary) Remaining cases are an Open Review (Retrospective RT Review) Remaining cases are an Open Review (Retrospective RT Review) See Section 12.2 for Portal Imaging Submission See Section 12.2 for Portal Imaging Submission 0921 (Endometrial) 0921 (Endometrial) First case is a Rapid Review First case is a Rapid Review

RTOG 0825 Blood detection scan must be performed within 1 wk of 2 nd step registration Blood detection scan must be performed within 1 wk of 2 nd step registration Scans on ALL cases are being collected by ACRIN for archiving. See section 12.3 for details Scans on ALL cases are being collected by ACRIN for archiving. See section 12.3 for details

Studies With IGRT Credentialing IGRT is Disease Site Specific (No Grandfathering between disease sites) Studies With Mandatory IGRT: Studies With Mandatory IGRT: 0631 (Spine Mets.) 0631 (Spine Mets.) 0813 (Lung) 0813 (Lung) 0915 (Lung) 0915 (Lung)

Studies With IGRT Credentialing IGRT Credentialing Required For Reduced Margins Only: IGRT Credentialing Required For Reduced Margins Only: 0539 (Meningioma) 0539 (Meningioma) 0920 (H/N) 0920 (H/N) 1008 (H/N) 1008 (H/N) For All Studies: For All Studies: Please read Section 5.0 for Protocol Specific Details. On the ATC website all of these studies have data submission information to the ITC ( click on study of choice for document)

IGRT Information

RTQA Contacts Betty O’Meara (215) Betty O’Meara (215) James Galvin(215) James Galvin(215) Ying Xiao(215) Ying Xiao(215) Denise Manfredi, Brain and CCOP (215) Denise Manfredi, Brain and CCOP (215) Nancy Linnemann, H&N and Sarcoma (215) Nancy Linnemann, H&N and Sarcoma (215) Julie McIlvaine, Lung ( 215) Julie McIlvaine, Lung ( 215) Jennifer Presley, GU (215) Jennifer Presley, GU (215) Sue McNulty, GI, GYN and Breast (215) Sue McNulty, GI, GYN and Breast (215) Joanne Hunter, Multiple Disease Sites (215) Joanne Hunter, Multiple Disease Sites (215) Erin Cunningham, Project Specialist(215) Erin Cunningham, Project Specialist(215) Tammy McGlade, Credentialing(215) Tammy McGlade, Credentialing(215) & Administrative Assistant & Administrative Assistant

R.T. Quality Assurance Questions????? Questions?????