The Imaging and Radiation Oncology Core The Imaging and Radiation Oncology Core (IROC) Houston QA Center’s International (IROC) Houston QA Center’s International Activities Outside North America Activities Outside North America David Followill AAPM Summer Meeting Anaheim, CA July 14, 2015
IROC Houston’s Mission Provide integrated radiation oncology and diagnostic imaging quality control programs in support of the NCI’s NCTN Network thereby assuring high quality data for clinical trials designed to improve the clinical outcomes for cancer patients worldwide
IROC Houston Verification of Institutions’ Delivery of Tumor Dose Reference calibration Evaluated by (NIST traceable) RPC Dosimeters Correction Factors: Field size & shape Evaluated by Depth of target RPC visits and Transmission factors chart review Treatment time Evaluated by Tumor Dose RPC phantoms
Countries and sites Monitored 56 countries
QA Program Components (since 2013) 1. Remote audits of machine output 376 (1,678) institutions, 2,778 (29,284) beams measured with TLD/OSLD Internationally (N America) 2. Patient Treatment record reviews 216 (3,008) charts reviewed 3. Credentialing – Phantoms (IMRT H&N) 87 (477) Phantom irradiations
Remote Audits of Machine Output • Verification of Reference Calibration for photon, proton and electron beams • Units of special design (Gamma Knife, CyberKnife, Tomotherapy) OSLDs TLD
Beam Output Monitoring Beam Output Audits (IROC/INST) Beam Output Audits (IROC/INST) P value ( =0.05) P value ( =0.05) Geographical Region Geographical Region Sample count Sample count Mean Mean Std Deviation Std Deviation N America N America 29284 29284 0.999 0.999 0.019 0.019 control control Australia/New Zealand Australia/New Zealand 544 544 0.989 0.989 0.018 0.018 0.000 0.000 China/ Hong Kong China/ Hong Kong 187 187 1.002 1.002 0.017 0.017 0.053* 0.053* Republic of Korea Republic of Korea 397 397 0.997 0.997 0.022 0.022 0.013 0.013 Japan Japan 84 84 0.991 0.991 0.017 0.017 0.000 0.000 Taiwan Taiwan 95 95 0.993 0.993 0.002 0.002 0.029 0.029 E Europe/ Russia E Europe/ Russia 104 104 1.005 1.005 0.038 0.038 0.002 0.002 W Europe W Europe 657 657 1.000 1.000 0.914* 0.914* 0.029 0.029 India/ Sri Lanka India/ Sri Lanka 71 71 1.009 1.009 0.042 0.042 0.000 0.000 Middle East Middle East 268 268 0.995 0.995 0.022 0.022 0.000 0.000 Africa Africa 48 48 1.006 1.006 0.024 0.024 0.011 0.011 Latin America Latin America 37 37 1.003 1.003 0.023 0.023 0.272* 0.272* SE Asia SE Asia 104 104 0.992 0.992 0.023 0.023 0.000 0.000 * not significantly different from N America (one way ANOVA) * not significantly different from N America (one way ANOVA)
Patient Chart Review RT Patient Chart Reviews Location Total dose points reviewed # dose points within criteria Percent passing N America 3008 2748 86.4% International 216 200 92.6% The chart review results between N America and all other international sites since 2012. Majority of these reviews were for brachytherapy treatments. No statistical difference between N America and International pass rates.
IMRT H&N Phantom Results IMRT H&N Phantom Location # irradiated # passed Percent passed North America 477 420 88.1% International 87* 76 87.4% *RT sites in 30 countries IMRT H&N phantom irradiation pass rate since 2012
Summary • IROC Houston is no longer just domestic as trials go international • Still work to be done with machine calibration • Phantoms continue to provide advanced technology E2E monitoring
Thank You Questions? www.irochouston.mdanderson.org
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