IROC Imaging and Radiation Oncology Quality Assurance for the NCTN

Transcription

1 IROC Imaging and Radiation Oncoogy Quaity Assurance for the NCTN Fran Laurie IROC Rhode Isand May 11, 2017

2 Presentation Objectives What is IROC Understand IROC s organization Learn about the services IROC provides to the NCTN How/When to interact with IROC Why is QA important

3 What is IROC?

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7 IROC s Structure American Coege of Radioogy Cinica Research Center in Phiadephia is the Grantee for the IROC Grant Sub-awards to: IROC Ohio PI: M.V. Knopp IROC Houston PI: D. Foowi IROC Phiadephia (RT) PI: Y. Xiao IROC Phiadephia (Imaging) PI: M. Rosen IROC Rhode Isand PI: T.J. FitzGerad IROC St. Louis PI: J. Michaski IROC Executive Committee Co-Directors: D. Foowi, Houston (RT) and M.V. Knopp, Ohio (Imaging) IROC Admin: Rosen/O Meara/Laurie

8 IROC s Mission Provide integrated radiation oncoogy and diagnostic imaging quaity contro programs in support of the NCI s NCTN Network thereby assuring high quaity data for cinica trias designed to improve the cinica outcomes for cancer patients wordwide

9 IROC s Core Services 1. Site Quaification (FQs, ongoing QA (OSLD, visits), proton approva, resources) 2. Tria Design Support/Assistance (Key contact QA centers, protoco review, tempates) 3. Credentiaing (Tiered system to minimize institution effort) 4. Data Management (Data coection, pre-review, post-review for anaysis) 5. Case Review (Pre-, on-, post-treatment reviews, faciitate review ogistics)

10 Key Contact QA Centers NCTN Group Radiation Oncoogy Imaging Aiance Rhode Isand Ohio COG Rhode Isand Rhode Isand ECOG-ACRIN Rhode Isand Phiadephia (DI) NRG Oncoogy Phiadephia (RT) Phiadephia (DI) SWOG Rhode Isand Ohio IROC Houston is the primary contact center for a RT credentiaing activities and questions. IROC Houston maintains the database for radiation and imaging faciities and provides this information to CTEP for the IROC Roster.

11 Site Quaification and Credentiaing Site Quaification requirements must be competed for sites to be eigibe to participate. Enroment to protocos with RT components requires that the treating RT faciities participate with the IROC Houston monitoring program. Credentiaing requirements may be protoco specific or may be modaity/technique specific. IROC is working to harmonize these requirements across the NCTN Groups to eiminate redundant requirements.

12 Tria Design Support/Assistance Review new protocos and amendments Ensure that the RT and Imaging guideines are technicay achievabe, ceary written and in agreement with NCI guideines Check that QA and data submission requirements are current and appropriate

13 Data Management Data coection Data management Case evauation Feedback to participating sites Submit review data to Statistica Center for study anaysis Report performance data to IPEC Data archiving

14 Case Review Diagnostic Imaging Centra Reviews Confirm eigibiity and staging Confirm response Confirm progression/reapse Correate patterns of faiure Can be performed in rea-time to direct patient treatment or retrospective to confirm oca patient management and reporting Can be performed on-site or remotey using secure VPN connections RT Reviews Interventiona reviews (pre-treatment or eary on-treatment) to assure that patient s treatment pan is per protoco requirements. Possibe to modify panning to protoco compiance Post treatment reviews performed to confirm patient s treatment was deivered per protoco. RT detais from this review are transferred for protoco anaysis.

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18 Research Resource Aduts Committee #Protocos #Patients DICOM Diagnostic Studies DICOM RT Treatment Pans Breast CNS Lung Lymphoma GI

19 Research Resource Pediatrics Committee #Protocos #Patients DICOM Diagnostic Studies DICOM RT Treatment Pans AALL 13 3,072 1,039 8 ACNS 22 3,111 16,651 1,546 AEWS 7 1,571 4, AHOD 10 2,812 29, ANBL 14 2,706 8, ARAR , AREN 5 7,250 11, ARST 10 2,123 6,

20 TRIAD Deveoped by the American Coege of Radioogy (ACR) Customized for use with NCTN trias and integrated with Rave Sophisticated anonymization abiity to de-identify PHI in DICOM Is being phased in across a NCTN Groups to transfer Diagnostic Imaging and Digita Radiotherapy Data. First COG Tria identified ANBL1531.

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22 Importance of QA Concusion: Current reports suggest protoco-compiant RT tends to decrease faiure rates & increase overa surviva, and ikey contributes to the abiity of the coected data to answer the centra tria question. Dharmarajan, K.V., et.a. (2015). Radiotherapy quaity assurance report from chidren's oncoogy group AHOD0031.Internationa Journa of Radiation Oncoogy, Bioogy, Physics, 91(5): This paper sets the standard for the cinica tria research testing the vaue of RT, and demonstrates that the time, money, effort of doing an extensive RT QA review is mandatory if the overa study resuts are to be beieved. Aso it shows the importance of physician education so to improve performance and decrease protoco deviations, with improved protoco compiance.

23 Z0011 was an important cinica tria that demonstrated imited axiary surgery was efficacious and tangentia RT was appropriate in patients with imited noda invovement. The protoco incuded guideines for the tangentia adjuvant RT but there was no centra review of the dose and voume during the tria. After the primary paper was pubished, efforts were made by Reshma Jagsi and QARC coeagues to review the RT information. These data demonstrated a number of study patients were treated with regiona RT and some patients received no RT at a. This further compicates strategies for future studies as the roe of imited regiona RT in breast cancer care remains ambiguous. If imaging and RT information had been acquired on-study, incuding reapse imaging, defining axiary voume for current NCTN studies woud be based on more secure evidence.

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26 IROC Contact Information RT Credentiaing questions NRG Oncoogy RT questions Diagnostic Imaging questions Aiance Diagnostic Imaging questions RT questions & Additiona Information at: ECOG-ACRIN Diagnostic Imaging questions RT questions SWOG Diagnostic Imaging questions RT questions TRIAD Support for issues instaing and utiizing the TRIAD Software T: or, E: