title: Successful implementation of image-guided radiation therapy quality assurance in the Trans Tasman Radiation Oncology Group 08.01 PROFIT Study.
abstract: OBJECTIVE
  The quality assurance (QA) of image-guided radiation therapy (IGRT) within clinical trials is in its infancy, but its importance will continue to grow as IGRT becomes the standard of care. The purpose of this study was to demonstrate the feasibility of IGRT QA as part of the credentialing process for a clinical trial.
  
  
  METHODS
  As part of the accreditation process for a randomized trial in prostate cancer hypofraction, IGRT benchmarking across multiple sites was incorporated. Each participating site underwent IGRT credentialing via a site visit. In all centers, intraprostatic fiducials were used. A real-time assessment of analysis of IGRT was performed using Varian's Offline Review image analysis package. Two-dimensional (2D) kV and MV electronic portal imaging prostate patient datasets were used, consisting of 39 treatment verification images for 2D/2D comparison with the digitally reconstructed radiograph derived from the planning scan. The influence of differing sites, image modality, and observer experience on IGRT was then assessed.
  
  
  RESULTS
  Statistical analysis of the mean mismatch errors showed that IGRT analysis was performed uniformly regardless of institution, therapist seniority, or imaging modality across the three orthogonal planes.
  
  
  CONCLUSIONS
  The IGRT component of clinical trials that include sophisticated planning and treatment protocols must undergo stringent QA. The IGRT technique of intraprostatic fiducials has been shown in the context of this trial to be undertaken in a uniform manner across Australia. Extending this concept to many sites with different equipment and IGRT experience will require a robust remote credentialing process.
authors.affiliation: Radiation Oncology Queensland, St. Andrews Hospital, Toowoomba, Queensland, Australia. mark.middleton@roq.net.au
authors.forename: Mark
authors.initials: M
authors.lastname: Middleton
authors.forename: Jim
authors.initials: J
authors.lastname: Frantzis
authors.forename: Brendan
authors.initials: B
authors.lastname: Healy
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.forename: Rebecca
authors.initials: R
authors.lastname: Murry
authors.forename: Tomas
authors.initials: T
authors.lastname: Kron
authors.forename: Ashley
authors.initials: A
authors.lastname: Plank
authors.forename: Charles
authors.initials: C
authors.lastname: Catton
authors.forename: Jarad
authors.initials: J
authors.lastname: Martin
mesh_terms: D000068:Accreditation / Q000592:standards*; D001315:Australia; D019985:Benchmarking; D002173:Cancer Care Facilities / Q000592:standards; D005240:Feasibility Studies; D057918:Fiducial Markers / Q000592:standards*; D006801:Humans; D008297:Male; D009864:Ontario; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011786:Quality Control; D018787:Radiation Oncology / Q000592:standards; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D061106:Radiotherapy Setup Errors / Q000517:prevention & control; D061089:Radiotherapy, Image-Guided / Q000592:standards*