The objective of the IROC Houston patient chart review program is to identify and correct dosimetry errors in the treatment of patients entered onto cooperative clinical trial studies. As a result of chart review, the radiotherapy data used by study groups is as accurate as possible. In addition, when errors are found, the IROC Houston dosimetrists provide feedback to the institution to ensure that the institution understands and corrects the error. Therefore, chart review impacts not just protocol patients, but all patients treated at that institution.
The IROC Houston presently reviews patient charts for the following cooperative study groups: NSABP, GOG, NCCTG, and RTOG. The IROC Houston does both external beam and brachytherapy chart review. In fact, the IROC Houston is the only quality assurance office that performs brachytherapy patient chart review, and only the IROC Houston and the RTOG headquarters dosimetry group perform independent reviews of external beam calculations.
IROC Houston offers two forms of patient chart review: type I is a comprehensive review, and type II is an alternate review. The type I comprehensive review is a retrospective dose recalculation and verification of protocol compliance. This review uses the IROC Houston data measured during the IROC Houston on-site review visits or TLD results from our TLD monitoring program coupled with our standard data. Our standard data set is a compilation of the characteristics of all the beams measured by the IROC Houston for each type of make, model and energy of a machine. The type II alternate review is designed to look for omitted data, transcription errors, reporting errors and compliance with protocol requirements. The treatment dose is not recalculated. The IROC Houston uses sampling techniques to determine whether a chart gets a type I or II review. The sampling process allows the IROC Houston to be more efficient yet not overlook any systematic dosimetry errors.