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Quirk S, Lovis J, Stenhouse K, Van Dyke L, Roumeliotis M, Thind K. Technical Note: A standardized automation framework for monitoring institutional radiotherapy protocol compliance. Med Phys 2021; 48:2661-2666. [PMID: 33619728 DOI: 10.1002/mp.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To establish a framework for the standardization of monitoring radiotherapy protocol compliance. METHODS An automated protocol compliance tool was developed using best practice in software design and a flexible framework to easily adapt to changing institutional standards. The Eclipse scripting environment was used to develop the application with the scripting application programing interface (API) and direct data extraction from ARIA. For each institutional protocol, external validation was specified in a JavaScript Object Notation (JSON) file that stores protocol specific constraints and evaluates compliance of the data from Eclipse and Aria. This tool was applied prospectively to a cohort of prostate cancer patients undergoing radiotherapy with a prescription regimen of 60 Gy in 20 fractions. RESULTS The prospective evaluation was performed on 58 prostate cancer patients. For this cohort, the mean (standard deviation) pass rate is 92.3% (6.1%). The overall fail rate is 6.0% (5.8%); the percentage of these failures is in 2.6% in Patient Assessment, 0% in Simulation, and 97.4% in Treatment Planning. CONCLUSIONS A protocol compliance application is developed and implemented in a standard radiotherapy information system. The application functionality is demonstrated on a cohort of 58 patients undergoing prostate radiotherapy, which highlights the utility of assessing adherence to institutional protocols. A unified method must be available for the community to ensure consistency in compliance reporting.
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Affiliation(s)
- Sarah Quirk
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Kailyn Stenhouse
- Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Michael Roumeliotis
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Kundan Thind
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Calgary, AB, Canada
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2
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Tsunoda AT, Ribeiro R, Reis RJ, da Cunha Andrade C, Moretti Marques R, Baiocchi G, Fin F, Zanvettor PH, Falcao D, Batista TP, Azevedo B, Guitmann G, Pessini SA, Nunes JS, Campbell LM, Linhares JC, Carneiro V, Coimbra F. Surgery in ovarian cancer - Brazilian Society of Surgical Oncology consensus. BJOG 2018; 125:1243-1252. [PMID: 29900651 DOI: 10.1111/1471-0528.15328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/22/2022]
Abstract
Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC. TWEETABLE ABSTRACT Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients.
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Affiliation(s)
- A T Tsunoda
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Albert Einstein Hospital, São Paulo, Brazil.,Positivo University, Curitiba, Brazil
| | - R Ribeiro
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil
| | - R J Reis
- Hospital Erasto Dorneles e Hospital Mãe de Deus, Porto Alegre, Brazil.,Brazilian Lutheran University, Porto Alegre, Brazil
| | - Cem da Cunha Andrade
- Gynaecological Oncology Department, Barretos Cancer Hospital, Barretos, Brazil.,Paulo Prata Medical University, Barretos, Brazil
| | | | - G Baiocchi
- Gynaecological Oncology Department, AC Camargo Cancer Centre, Sao Paulo, Brazil
| | - F Fin
- Gynaecological Oncology Department, Hospital São Vicente, Curitiba, Brazil.,Faculdade Evangélica de Curitiba, Curitiba, Brazil
| | - P H Zanvettor
- Gynaecological Oncology Department, Aristides Maltez Hospital, Salvador, Brazil.,AMO Clinic, Salvador, Brazil
| | - D Falcao
- Gynaecological Oncology Department, Aristides Maltez Hospital, Salvador, Brazil
| | - T P Batista
- Surgery Department, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Brb Azevedo
- Hospital São Vicente, Curitiba, Brazil.,Instituto de Hemato Oncologia do Paraná, Curitiba, Brazil
| | - G Guitmann
- Brazilian National Cancer Institute, Rio de Janeiro, Brazil.,Americas Hospital, Rio de Janeiro, Brazil
| | - S A Pessini
- Gynaecological Oncology Department, Fundação Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - J S Nunes
- Hospital Erasto Gaertner, Curitiba, Brazil.,Instituto de Oncologia do Paraná, Curitiba, Brazil
| | | | - J C Linhares
- Gynaecological Oncology Department, Hospital Erasto Gaertner, Curitiba, Brazil.,Instituto de Oncologia do Paraná, Curitiba, Brazil
| | - V Carneiro
- Hospital de Câncer de Pernambuco, Recife, Brazil Instituto de Medicina Integral Professor Fernando Figueira NeoH - Núcleo Especializado em Oncologia e Hematologia D'OR, Recife, Brazil
| | - Fjf Coimbra
- AC Camargo Cancer Centre, Sao Paulo, Brazil.,Brazilian Society of Surgical Oncology 2016/2017, Sao Paulo, Brazil
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3
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Multidisciplinary quality assurance and control in oncological trials: Perspectives from European Organisation for Research and Treatment of Cancer (EORTC). Eur J Cancer 2017; 86:91-100. [PMID: 28964907 DOI: 10.1016/j.ejca.2017.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/25/2017] [Indexed: 02/06/2023]
Abstract
Quality assurance (QA) programmes are one of the mainstays of clinical research and constitute the pillars on which European Organisation for Research Treatment of Cancer (EORTC) delivers multidisciplinary therapeutic progress. Changing practice treatments require solid evidence-based data, which can only be achieved if integral QA is part of the infrastructure sustaining research projects. Cancer treatment is a multimodality approach, which is often applied either in sequence and/or in combination. Each modality plays a key role in cancer control. The modalities by which QA is applied varies substantially within and across the disciplines. In addition, translational and diagnostic disciplines take an increasing role in the era of precision medicine. Building on the structuring effect of clinical research with fully integrated multidisciplinary QA programmes associated with the solutions addressing the chain of custody for biological material and data integrity as well as compliance ensure at the same time validity of clinical research output but also have a training effect on health care providers, who are more likely to apply such principles as routine. The principles of QA are therefore critical to be embedded in multidisciplinary infrastructure to guarantee therapeutic progress. These principles also provide the basis for the functioning of multidisciplinary tumour board. However, technical, operational and economic challenges which go with the implementation of such programmes require optimal know-how and the coordination of the multiple expertise and such efforts are best achieved through centralised infrastructure.
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4
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Tanis E, Caballero C, Collette L, Verleye L, den Dulk M, Lacombe D, Schuhmacher C, Werutsky G. The European Organization for Research and Treatment for Cancer (EORTC) strategy for quality assurance in surgical clinical research: Assessment of the past and moving towards the future. Eur J Surg Oncol 2016; 42:1115-22. [DOI: 10.1016/j.ejso.2016.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/31/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022] Open
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5
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Efficacy and tolerability of two scalp cooling systems for the prevention of alopecia associated with docetaxel treatment. Support Care Cancer 2013; 21:2565-73. [PMID: 23636645 DOI: 10.1007/s00520-013-1804-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Chemotherapy-induced alopecia is very distressing for a patient and may have an impact on treatment decisions. On docetaxel-based therapy, alopecia occurs in a substantial proportion of patients. We aimed to investigate whether two different methods of scalp cooling can prevent hair loss. METHODS In this open-label, prospective, nonrandomized trial, patients with solid tumors receiving docetaxel in a palliative setting were allocated according to patients' preference to short-term cooling (over 45 min postinfusion) with a Paxman PSC-2 machine (PAX), with cold cap (CC), or no cooling. The combined endpoint was alopecia World Health Organisation (WHO) III or IV or the necessity to wear a wig. Study identifier is Clinicaltrials.gov NCT01008774. RESULTS Two hundred thirty-eight patients were included in the trial (128 patients PAX, 71 CC, and 39 no cooling). Number of cycles (median 4) and median docetaxel doses were similar across groups (55-60 mg/day on weekly therapy, 135-140 mg/day on 3-weekly therapy). Alopecia occurred with PAX, CC, and no cooling under 3-weekly docetaxel in 23, 27, and 74% and under weekly docetaxel in 7, 8, and 17%, respectively. Overall, cooling (PAX and CC combined) reduced risk of alopecia by 78% (hazard ratio 0.22; 95% confidence interval 0.12 to 0.41). CC and PAX prophylaxis led to the same degree of prevention of alopecia. Adverse events (AE) were reported in 5% (most frequently, sensation of cold), and 30 patients (13%) discontinued cooling measures after cycle 1. CONCLUSIONS In this first comparison published to date, both PAX and CC offer efficacious protection against hair loss, in particular when docetaxel is administered in a 3-weekly interval.
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Quality assurance in radiotherapy on a national level; experience from Norway: the KVIST initiative. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013; 13:35-44. [PMID: 24611030 PMCID: PMC3942814 DOI: 10.1017/s1460396912000544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/14/2012] [Accepted: 10/08/2012] [Indexed: 11/13/2022]
Abstract
Background and purpose In radiotherapy (RT), there are high requirements for quality assurance (QA) in all the steps of the process. Development of QA systems are demanding in terms of financial and human resources. A national QA programme (KVIST) has been established in Norway to facilitate implementation of QA activity on hospital level. Method The KVIST organisation comprises the KVIST team, the reference group (RG) and the working groups (WGs). The KVIST team is multidisciplinary and are employed in permanent positions. The RG acts as an advisory body for the KVIST team in defining and ranking the priority of projects. Relevant national QA projects are identified in collaboration with the RG, and WGs are established to carry out the various projects. Result Several national consensus documents have been prepared by the various WGs. Systems for incident handling and activity reporting have been established and clinical audits have been implemented in Norwegian RT. Guidelines for RT of various diagnoses have also been prepared in collaboration with National Cancer groups. Conclusion The KVIST programme has been very well acknowledged in the Norwegian RT community. It has succeeded in creating a positive attitude towards QA and improved the communication between centres and the various professions.
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7
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Krishnankutty B, Bellary S, Kumar NBR, Moodahadu LS. Data management in clinical research: An overview. Indian J Pharmacol 2012; 44:168-72. [PMID: 22529469 PMCID: PMC3326906 DOI: 10.4103/0253-7613.93842] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 11/08/2011] [Accepted: 01/01/2012] [Indexed: 01/21/2023] Open
Abstract
Clinical Data Management (CDM) is a critical phase in clinical research, which leads to generation of high-quality, reliable, and statistically sound data from clinical trials. This helps to produce a drastic reduction in time from drug development to marketing. Team members of CDM are actively involved in all stages of clinical trial right from inception to completion. They should have adequate process knowledge that helps maintain the quality standards of CDM processes. Various procedures in CDM including Case Report Form (CRF) designing, CRF annotation, database designing, data-entry, data validation, discrepancy management, medical coding, data extraction, and database locking are assessed for quality at regular intervals during a trial. In the present scenario, there is an increased demand to improve the CDM standards to meet the regulatory requirements and stay ahead of the competition by means of faster commercialization of product. With the implementation of regulatory compliant data management tools, CDM team can meet these demands. Additionally, it is becoming mandatory for companies to submit the data electronically. CDM professionals should meet appropriate expectations and set standards for data quality and also have a drive to adapt to the rapidly changing technology. This article highlights the processes involved and provides the reader an overview of the tools and standards adopted as well as the roles and responsibilities in CDM.
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Affiliation(s)
- Binny Krishnankutty
- Global Medical Affairs, Dr. Reddy's Laboratories Ltd., Ameerpet, Hyderabad, India
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8
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Duda SN, Shepherd BE, Gadd CS, Masys DR, McGowan CC. Measuring the quality of observational study data in an international HIV research network. PLoS One 2012; 7:e33908. [PMID: 22493676 PMCID: PMC3320898 DOI: 10.1371/journal.pone.0033908] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 02/19/2012] [Indexed: 11/29/2022] Open
Abstract
Observational studies of health conditions and outcomes often combine clinical care data from many sites without explicitly assessing the accuracy and completeness of these data. In order to improve the quality of data in an international multi-site observational cohort of HIV-infected patients, the authors conducted on-site, Good Clinical Practice-based audits of the clinical care datasets submitted by participating HIV clinics. Discrepancies between data submitted for research and data in the clinical records were categorized using the audit codes published by the European Organization for the Research and Treatment of Cancer. Five of seven sites had error rates >10% in key study variables, notably laboratory data, weight measurements, and antiretroviral medications. All sites had significant discrepancies in medication start and stop dates. Clinical care data, particularly antiretroviral regimens and associated dates, are prone to substantial error. Verifying data against source documents through audits will improve the quality of databases and research and can be a technique for retraining staff responsible for clinical data collection. The authors recommend that all participants in observational cohorts use data audits to assess and improve the quality of data and to guide future data collection and abstraction efforts at the point of care.
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Affiliation(s)
- Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
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9
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Fairchild A, Bar-Deroma R, Collette L, Haustermans K, Hurkmans C, Lacombe D, Maingon P, Poortmans P, Tomsej M, Weber DC, Gregoire V. Development of clinical trial protocols involving advanced radiation therapy techniques: the European Organisation for Research and Treatment of Cancer Radiation Oncology Group approach. Eur J Cancer 2012; 48:1048-54. [PMID: 22387181 DOI: 10.1016/j.ejca.2012.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/09/2012] [Indexed: 12/25/2022]
Abstract
The European Organisation for Research and Treatment of Cancer (EORTC) Master Protocol for phase III radiation therapy (RT) studies was published in 1995 to define in a consistent sequence the parameters which must be addressed when designing a phase III trial 'from the rationale to the references'. This was originally implemented to assist study investigators and writing committees, and to increase homogeneity within Radiation Oncology Group (ROG) study protocols. However, RT planning, delivery, treatment verification and quality assurance (QA) have evolved significantly over the last 15 years and clinical trial protocols must reflect these developments. The goal of this update is to describe the incorporation of these developments into the EORTC-ROG protocol template. Implementation of QA procedures for advanced RT trials is also briefly described as these essential elements must also be clearly articulated. This guide may assist both investigators participating in current ROG trials and others involved in writing an advanced RT trial protocol.
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10
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Quality assurance for prospective EORTC radiation oncology trials: The challenges of advanced technology in a multicenter international setting. Radiother Oncol 2011; 100:150-6. [DOI: 10.1016/j.radonc.2011.05.073] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/23/2011] [Accepted: 05/29/2011] [Indexed: 11/20/2022]
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Orihuela-Espina F, Leff DR, James DRC, Darzi AW, Yang GZ. Quality control and assurance in functional near infrared spectroscopy (fNIRS) experimentation. Phys Med Biol 2010; 55:3701-24. [PMID: 20530852 DOI: 10.1088/0031-9155/55/13/009] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Verleye L, Ottevanger P, van der Graaf W, Reed N, Vergote I. EORTC–GCG process quality indicators for ovarian cancer surgery. Eur J Cancer 2009; 45:517-26. [DOI: 10.1016/j.ejca.2008.09.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 09/13/2008] [Accepted: 09/30/2008] [Indexed: 10/21/2022]
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13
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Bekelman JE, Yahalom J. Quality of Radiotherapy Reporting in Randomized Controlled Trials of Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma: A Systematic Review. Int J Radiat Oncol Biol Phys 2009; 73:492-8. [DOI: 10.1016/j.ijrobp.2008.04.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 04/14/2008] [Accepted: 04/14/2008] [Indexed: 10/21/2022]
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14
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Matsuo Y, Takayama K, Nagata Y, Kunieda E, Tateoka K, Ishizuka N, Mizowaki T, Norihisa Y, Sakamoto M, Narita Y, Ishikura S, Hiraoka M. Interinstitutional variations in planning for stereotactic body radiation therapy for lung cancer. Int J Radiat Oncol Biol Phys 2007; 68:416-25. [PMID: 17363190 DOI: 10.1016/j.ijrobp.2006.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Revised: 12/08/2006] [Accepted: 12/14/2006] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to assess interinstitutional variations in planning for stereotactic body radiation therapy (SBRT) for lung cancer before the start of the Japan Clinical Oncology Group (JCOG) 0403 trial. METHODS AND MATERIALS Eleven institutions created virtual plans for four cases of solitary lung cancer. The created plans should satisfy the target definitions and the dose constraints for the JCOG 0403 protocol. RESULTS FOCUS/XiO (CMS) was used in six institutions, Eclipse (Varian) in 3, Cadplan (Varian) in one, and Pinnacle3 (Philips/ADAC) in one. Dose calculation algorithms of Clarkson with effective path length correction and superposition were used in FOCUS/XiO; pencil beam convolution with Batho power law correction was used in Eclipse and Cadplan; and collapsed cone convolution superposition was used in Pinnacle3. For the target volumes, the overall coefficient of variation was 16.6%, and the interinstitutional variations were not significant. For maximal dose, minimal dose, D95, and the homogeneity index of the planning target volume, the interinstitutional variations were significant. The dose calculation algorithm was a significant factor in these variations. No violation of the dose constraints for the protocol was observed. CONCLUSION There can be notable interinstitutional variations in planning for SBRT, including both interobserver variations in the estimate of target volumes as well as dose calculation effects related to the use of different dose calculation algorithms.
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Affiliation(s)
- Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University, Kyoto, Japan
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15
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Blomgren KJ, Sundström A, Steineck G, Wiholm BE. Interviewer variability - quality aspects in a case-control study. Eur J Epidemiol 2006; 21:267-77. [PMID: 16685577 DOI: 10.1007/s10654-006-0017-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2006] [Indexed: 11/25/2022]
Abstract
Quality assurance and quality control are important for the reliability of case-control studies. Here we describe the procedures used in a previously published study, with emphasis on interviewer variability. To evaluate risk factors for acute pancreatitis, information including previous diagnoses and medication was collected from medical records and by telephone interviews from 462 cases and 1781 controls. Quality assurance procedures included education and training of interviewers and data validity checks. Quality control included a classification test, annual test interviews, expert case validation, and database validation. We found pronounced variations between interviewers. The maximal number of interviews per day varied from 3 to 9. The adjusted average (95% CI) number of diagnoses captured per interview of cases was 4.1 (3.8-4.3) and of controls 3.5 (3.4-3.7) (excluding one deviating interviewer). For drugs, the average (95% CI) number per interview was 3.9 (3.7-4.1) for cases and 3.3 (3.2-3.4) for controls (excluding one deviating interviewer). One of the fourteen interviewers deviated significantly from the others, and more so for controls than for cases. This interviewer's data ;were excluded. Nonetheless, data concerning controls more frequently needed correction and supplementation than for cases. Erroneous coding of diagnoses and medication was also more frequent among controls. Thus, a system for quality control of coding practices is crucial. Variability in interviewers' ability to ascertain information is a possible source of bias in interview-based case-control studies when "blinding" cannot be achieved.
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Affiliation(s)
- Kerstin J Blomgren
- The Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Coffin CS, Burak KW, Hart J, Gao ZH. The impact of pathologist experience on liver transplant biopsy interpretation. Mod Pathol 2006; 19:832-8. [PMID: 16575397 DOI: 10.1038/modpathol.3800605] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We studied the impact of pathologist experience on liver transplant biopsy interpretation for cases designated 'nonspecific' by pathologists at a nontransplant center. Among 102 consecutive liver transplant biopsies from 92 patients performed at the Foothills Medical Center, 30 liver biopsies from 23 patients were designated 'nonspecific' by the local pathologist. These biopsy slides were independently reviewed by an expert in liver transplant pathology at a major US transplant center. The expert pathologist was given only the information on the original requisition. In seven biopsies from five patients, there was full agreement between the external expert and the local pathologist. In 10 biopsies from six patients, the expert concurred with the initial assessment but emphasized critical negatives such as 'no evidence of rejection or recurrent hepatitis'. A discrepant diagnosis was found in 13 biopsies from 12 patients. In five biopsies from four patients, the revised diagnoses were inaccurate due to insufficient or misleading clinical information on the requisition. In eight biopsies from eight patients, the revised diagnoses were proven to be correct by clinicopathologic correlation. Our study shows that pathology expertise helped to clarify the diagnosis in about 27% of cases, which justifies the cost of obtaining a second opinion in difficult biopsies. Misinterpretation by the expert pathologist in up to 17% of biopsies highlights the importance of direct communication between hepatologist and pathologist in order to achieve a correct diagnosis. Familiarity with those cases with relatively uncommon histology, a diligent search for subtle morphologic changes, and use of standard terminology could improve the quality of liver transplant biopsy interpretation in a nontransplant center.
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Affiliation(s)
- Carla S Coffin
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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17
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Brandt CA, Argraves S, Money R, Ananth G, Trocky NM, Nadkarni PM. Informatics tools to improve clinical research study implementation. Contemp Clin Trials 2006; 27:112-22. [PMID: 16388990 DOI: 10.1016/j.cct.2005.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 11/19/2005] [Accepted: 11/22/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are numerous potential sources of problems when performing complex clinical research trials. These issues are compounded when studies are multi-site and multiple personnel from different sites are responsible for varying actions from case report form design to primary data collection and data entry. METHODS We describe an approach that emphasizes the use of a variety of informatics tools that can facilitate study coordination, training, data checks and early identification and correction of faulty procedures and data problems. The paper focuses on informatics tools that can help in case report form design, procedures and training and data management. CONCLUSION Informatics tools can be used to facilitate study coordination and implementation of clinical research trials.
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Affiliation(s)
- Cynthia A Brandt
- Yale School of Medicine, Center for Medical Informatics, New Haven, CT 06520-8009, USA.
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18
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Poortmans PM, Davis JB, Ataman F, Bernier J, Horiot JC. The quality assurance programme of the Radiotherapy Group of the European Organisation for Research and Treatment of Cancer: past, present and future. Eur J Surg Oncol 2005; 31:667-74. [PMID: 16100781 DOI: 10.1016/j.ejso.2005.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
As early as in 1982, the European Organisation for Research and Treatment of Cancer Radiotherapy Group established a quality assurance programme. In the course of 20 years, quality assurance procedures have become a vast and important part of the activities of the group. Today, the membership committee uses standard procedures based on minimal requirements to evaluate current members and new membership applications. Moreover, for every new trial, specific quality assurance procedures are an integral part of the preparation of the protocol and executed under the responsibility of the study coordinator. With the growing complexity of the radiotherapy techniques used in the framework of the more recent trials, quality assurance procedures have also become more complex including trial specific phantom based measurements. Future ways to evaluate all steps of the radiotherapy process using a common platform connecting all users with the internet are currently under development.
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Affiliation(s)
- P M Poortmans
- Department of Radiotherapy, Dr Bernard Verbeeten Instituut, Tilburg, The Netherlands.
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19
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Peeters KCMJ, van de Velde CJH. Surgical quality assurance in rectal cancer treatment: the key to improved outcome. Eur J Surg Oncol 2005; 31:630-5. [PMID: 15878260 DOI: 10.1016/j.ejso.2005.02.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 02/10/2005] [Indexed: 12/20/2022] Open
Abstract
Surgery is the key to cure for patients with rectal cancer. Surgical techniques are evolving with conventional blunt dissection being increasingly abandoned for the sake of total mesorectal excision (TME), leading to favourable clinical and functional outcome. Surgical quality assurance programmes, involving training of general surgeons to adopt the TME technique, have proven to be feasible and result in improved outcome compared to historical controls. In this overview, developments in rectal cancer treatment are highlighted, the relation of surgeon and/or hospital volume with treatment outcome is discussed, and future directions in optimising rectal cancer treatment are considered.
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Affiliation(s)
- K C M J Peeters
- Department of Surgery, K6-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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20
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van Krieken JHJM, Nagtegaal ID. Pathological quality assurance in gastro-intestinal cancer. Eur J Surg Oncol 2005; 31:675-80. [PMID: 15908166 DOI: 10.1016/j.ejso.2005.02.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 02/10/2005] [Indexed: 11/21/2022] Open
Abstract
Quality assurance has become an integrated and important part of surgical pathology. Not only laboratory quality systems and quality control of pathology reporting have been introduced, also interdisciplinary quality systems are being developed. This review focuses on the different aspects of quality assurance that can nowadays be used in the daily practice of pathology management of gastrointestinal cancers, especially, gastric- and colorectal cancer. Own data are, especially, derived from the recently conducted clinical trial on pre-operative radiotherapy for rectal cancer and emphasize the importance of multidisciplinary approaches.
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Affiliation(s)
- J H J M van Krieken
- Pathology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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