2. DOSE VOLUME HISTOGRAM WIZARDTool accepts numeric data based on the composite delivery of all plans from any treatment planning systemThe user selects the structures and type of DVHThe user reviews the data for quality control at time of data submission

INTRODUCTIONThe Michigan Radiation Oncology Quality Consort- ium (MROQC) was created in 2011 with six partner institutions to share best practices in radiation thera- py methods and outcomes for early stage breast and lung cancer patientsMROQC has expanded to 14 institutions statewide to include different types and sizes of practice environ- mentsA database was created to include physician and patient reported outcomes, physics data, and photo- graphs for breast patientsData elements were determined by a multi- disciplinary and multi-institutional team including physicists, physicians, and a statisticianIt is funded by Blue Cross Blue Shield of Michigan and coordinated by the University of Michigan

MATERIALS & METHODS

MATERIALS & METHODS (cont.)

Dynamic graphs created with Matlab for the dose volume histogram (DVH) tool

Java and Pixelmed DICOM library are used for the DICOM upload toolEach patient has an institutional ID only known at the institution and an MROQC ID which denotes the patient in the databaseEach person doing data entry uses two-factor authentication

1. WEB-BASED QUESTIONNAIRESFacility-specific questionnaire covers hardware, software and standard practices

Patient-specific questionnaire covers:

SimulationTarget definition for breast and lungDose prescriptionTreatment planning Treatment delivery

Three tools were created to capture physics data: web-based questionnaires, a dose volume histogram wizard, and a DICOM-RT anonymizer for plans.

DATABASE

GOALDescribe elements of the physics portion of the data- base & example analysis regarding practice patterns

RESULTSACKNOWLEDGEMENTS

As of July 2013, survey, DVH, and DICOM-RT data have been submitted for more than 1,000 patientsData quality is regularly monitored by the statistical and physics teamAn audit strategy has been developed which includes an onsite evaluation

RESULTS (cont.)

Web-based questionnairesRemoval of redundant questionsRewording of questions which inadequately captured the actual practice

DVH tool – breast cancer patients Data for the ipsilateral lung structure no longer collected because average doses <2.5 Gy Surgical cavity structure optional because it is not always contoured

DICOM-RT anonymizer toolAttestation statement added Internal error reporting launched

SUMMARYA database was created to capture detailed physics information from web-based questionnaires, and DVH and DICOM-RT plan dataData continues to be regularly submitted for eligible breast and lung cancer patientsHigh quality data are crucial for determining how treatment technique and doses affect patient outcomes

User feedback and a review of the data quality have led to the following improvements.

The authors acknowledge Tara Hackel, Jennifer Steers, and James Irrer who assisted in the design and created some of the software used in the MROQC database. The authors also acknowledge advice provided by Marc Kessler, Wayne Keranen and Eduardo Acosta throughout this process.

This work is funded by Blue Cross Blue Shield of Michigan. The funding bodyplayed no role in the design and conduct of the study or preparation, review, or approval of this work.

Lung

cancer

patients

A Physics Database for a Multi-Institutional Quality ConsortiumJM Moran1, M Feng1, L Benedetti2, M McMullen3, MM Matuszak1, T Nurushev4, M Hess1, KA Griffith1, J Hayman1, J Fisher5, S Brossard6, M Grubb1, L Pierce1 1University of Michigan, Ann Arbor, 2William Beaumont Hospital, Royal Oak, 3St. Joseph Mercy Hospital, Ann Arbor, 4Henry Ford Health System, Detroit, 5Mercy Health Partners, Muskegon, 6Munson Medical Center, Traverse City Michigan Radiation Oncology Quality Consortium

MROQC

Left Breast: Use of Breath Hold Control

6%

Lung: Use of Breath Hold Control

Breast: Number of Segments per Plan

None70%

With Device28%

Voluntary2%

16-100

<543%

>10011%

40%5-15

Lung: Number of Segments per Plan

<540%

16-10011%

>10030%

19%5-15

None82%

Use of ITV16%

With Device1%

Other1%

Sample searchable text-only preview from the upload processProtected health information (PHI) are removed during uploadThe user reviews the data for absence of PHI before final submission

3. DICOM-RT ANONYMIZER TOOL

Breast

cancer

patients

Primary tumor PTV

Involved nodal PTV*, Elective nodal PTV*, Nodal PTV*

Normal lung: Right + Left Lung minus GTV or CTV

If within 2 cm of 50% isodose surface: Spinal Cord, Esophagus**,

Heart, Brachial Plexus

Targets

Organs at risk

*Nodal PTVs are only submitted if nodes are contoured separately from other target volumes. The options allow for variations in practice among institutions.**Instructions are provided to follow the RTOG guidelines for contouring the esophagus.

Contoured treated breast or surrogate based on 95% isodose surface

Surgical cavity

Ipsilateral Lung, Heart if within 2 cm of the 50% isodose surface

Targets

Organs at risk

Structures for which DVHs are submitted