1	R.T. Quality Assurance Robert Lustig, MD Betty Martin, Director Lorraine Quarles, Senior Dosimetrist Denise Manfredi Nancy Linnemann Julie McIlvaine Joanne Hunter Tammy McGlade, Administrative Assistant
2	R.T. Quality Assurance The RTQA staff is responsible for coordinating the review process for the radiation treatments delivered on protocol studies. The two step process involves Initial Review- QA Radiation Oncologist and dosimetrist Final Review- Study Chair and dosimetrist
3	Studies with Initial Review The purpose of the Initial review is to identify any protocol violations and notify the institution early enough in the treatment so corrections can be made. QA radiation oncologist and dosimetrist review the initial data requested in section 12 that is due within 1 week of the start of RT
4	Data submission requirements for studies with Initial Review T2 Form Prospective information about the planned radiation treatment This shows us that the treating physician has interpreted the protocol correctly Planned total dose must be filled in on the form
5	T3 Simulation Film This is an example of a Simulation Film. They will have field shaping drawn on them with a wax pencil. These show what the physician intends to treat.
6	T3 This is a Digitally Reconstructed Radiograph (DRR). These are replacing Simulation films. This is done on a computer, the Physician does the field shaping from the CT plan.
7	T3 Port film This is an example of a port film on hard film. These films show what will actually be treated. At the review these are compared to the sim/ DRR.
8	T3 This is a Portal image captured digitally. These will be printed out on paper. Please do not put label over field identifiers
9	T4/ TL Forms On older studies These forms no longer have to be filled out
10	T4/TL Computer dose calculation data
11	To Summarize: data submission for studies with Initial review Data to be submitted to RTQA Dept. within one week of start of radiation treatment: T2 - Protocol treatment form T3 - Initial simulation/DRR’s & portal Images T4 - Computer generated dose calculation data
12	Transmittal Form The Dosimetry transmittal form should be used when RT data is sent to RTOG headquarters. This does not replace identifying films with the appropriate labels. Also submit this form to suppress RT data
13	Submitting the data If you submit multiple cases together, they must be separated from each other with clips Please do not staple different coded data together. Put a label on each film, each paper. Do not put label over field name Label template available on our website
14	When all the Initial Data is received what happens? Makes sure field borders match protocol specification.(T3) Compares films to ensure what is planned to be treated will actually be treated (T3). Verifies doses on T2 match Section 6 in protocol. Reviews the treatment plan(T4) for protocol compliance.
15	Z2 Form The Z2 form 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 the Z2 form to ensure appropriate credit.
16	Initial review: “Deviation” Memorandum (Blue) RTQA Rad Onc has found a variation in RT data submitted with the protocol parameters. Still submit the final RT data
17	Initial review: “Deviation” Memorandum (yellow) This memorandum means it is too late for changes in treatment to be made. Still submit the final RT data
18	R. T. Quality Assurance Final Review 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 Scores are given for total dose delivered, field borders, dose fractionation, and total elapsed days of treatment
19	Data Collection Section 12
20	For IMRT/ 3D-CRT studies Section 12.2 -12.2.1 are your guidelines for submission 12.2 Summary of Dosimetry Data Submission for 3DCRT and IMRT Submit to ITC; see Section 12.2.1 Item Due Preliminary Dosimetry Information Within 1 week of start of RT 􀂃 Digital Data Submission Form (DDSI) 􀂃 CT data, critical normal structures, all GTV, CTV, and PTV contours 􀂃 Simulation films and/or digital film images for all initial treatment fields and orthogonal set up pair 􀂃 First day port films (or digital images) of all initial treatment fields and orthogonal set up pair 􀂃 Digital beam geometry for initial and boost beam sets 􀂃 Doses for initial and boost sets of concurrent treated beams 􀂃 Digital DVH data for all required critical normal structures, GTV, CTV, and PTVs for total dose plan 􀂃 Hard copy color isodose distributions for total dose plan as described in QA guidelines Item Due Final Dosimetry Information Within 1 week of RT end 􀂃 Radiotherapy Form (T1) [copy to HQ and ITC] 􀂃 Daily Treatment Record 􀂃 Simulation films and/or digital film images (or digital images) of all boost treatment fields and orthogonal set up pair 􀂃 First day port films of all boost treatment fields and orthogonal set up pair 􀂃 Modified digital patient data as required through consultation with Image Guided Therapy QA Center 12.2.1 Digital Data Submission to ITC Digital data submission may be accomplished using magnetic tape or the Internet. For network submission: The FTP account assigned to the submitting institution by the ITC shall be used, and e-mail identifying the data set(s) being submitted shall be sent to: itc@castor.wustl.edu For tape submission: Please contact the ITC about acceptable tape types and formats. Hardcopies accompanying digital data should be sent by mail or Federal Express and should be addressed to: Image-Guided Therapy Center (ITC) ATTN: Roxana Haynes 4511 Forest Park, Suite 200 St. Louis, MO 63108 314-747-5415 FAX 314-747-5423
21	Patient Calendar
22	RTQA Final Review Data Submission Due within one week of completion of Radiation Treatment: T1 – Radiotherapy Form T5 – RT Treatment Record/Daily Chart T6 – Summated isodose distribution T7 – Electron field documentation T8/TP – Simulation or DRR’s/Portal images of all Cone Down or Boost fields TL – Computer dose calculation data DV – Dose Volume Histogram
23	T1 Radiotherapy Form T1 form is submitted after RT has been completed Total dose must reflect exact amount of radiation patient received
24	T5
25	T6
26	T7 Acceptable electron field documentation includes: Portal images Simulation or DRR images with fields delineated Photos with fields delineated Anatomical diagrams with fields delineated
27	T3 T8
28	T3 T8
29	DV (Dose Volume Histogram)
30	Z4 Form RTQA Form requesting additional data to complete preparation for final review by Study Chair Requires a prompt response
31	RTQA Contacts Betty Martin (215) 574-3209 Lorraine Quarles (215) 574-3181 Denise Manfredi (215) 717-2755 Nancy Linnemann (215) 717-0853 Julie McIlvaine (215) 574-3229 Joanne Hunter (215) 574-3222 Tammy McGlade (215) 574-3219 Administrative Assistant
32	RTOG Headquarters RTQA Department
33	R. T. Quality Assurance QUESTIONS?????