Improving Health Through Medical Physics

AAPM Newsletter — Volume 42 No.5 — September|October 2017


Picture of Hania Al-Hallaq
The Physicists Role and Workload in NTCN Clinical Trials: Moving from Denial to Acceptance
At the Annual Meeting in Denver, CO, physicists involved in clinical trials and the NRG Physics Committee provided a one-hour summary in the 'Professional Track' to highlight the physicist's role in NTCN trials. The 7:30 AM session began with some humor by Andrea Molineu, who likened the process of credentialing to moving from denial to acceptance regarding a physicist's involvement. After summarizing the resources to the physicist by IROC Houston, Hania Al-Hallaq described the process of credentialing for SBRT oligometastases trials (NRG-BR001 & BR002). She mentioned that these complex protocols often have "gray zones" of plans that are deemed acceptable, which presents its own challenges. Finally, the session concluded with James Monroe presenting the results of an NRG survey to assess the role of and hours spent by physicists in supporting clinical trials. In addition to viewing the presentation online, a quick summary of the take-home points is provided below.
As a physicist, how do I support clinical trials at my institution?
Physicists are responsible for ensuring that QA metrics are satisfied at their institution to enable them to participate in NTCN clinical trials. The primary source to find this information for each trial is IROC Houston's website. Under the 'Credentialing' tab you will find the list of QA requirements along with helpful information specific to that protocol.
How can I find out if we have met all the requirements for a trial? How can I get my credentialing letter once I've completed all the requirements?
Submit the 'Credentialing Status Inquiry Form' on IROC's website.
How often should I update my facility questionnaire?
The facility questionnaire must be updated every 6 months in order to receive annual OSLDs or phantoms. Because it auto-populates, you won't have to type in anything if there have been no changes at your institution.
Which online accounts must I maintain?
Both a CTEP-IAM and a TRIAD account are needed to access protocols and upload digital data, respectively.
What additional resources has NRG developed for physicists?
  • Center for Innovation in Radiation Oncology (CIRO) provides several tools on its website including a) site-specific protocol templates, b) structure library names, c) contouring atlases, and d) Eclipse scripting API tools for protocols, click here.
  • Credentialing requirements are now consolidated to a single table/location in recent protocols.
  • Download the protocol-specific DVH form that will be used to evaluate your plan from CIRO's website.
  • Search the AAPM virtual library for "Clinical Trials."
What are some hints to expedite protocol credentialing?
  1. Combine as many techniques (motion management, use of FFF beam, single isocenter for multiple targets) into a single phantom irradiation.
  2. Request the phantom first as there is a waiting list to receive the phantom and it takes about 6 weeks to process the results by IROC.
  3. Don't be shy about emailing the Physics PI (listed on the front of the protocol), NRG, or IROC Houston with questions.
How do I keep up to date with the latest versions of a protocol as it seems that they undergo multiple revisions?
The best way to ensure you are using the latest version is to download it directly from the CTSU website. Protocol revisions can occur at any time and it's the responsibility of the institution to ensure compliance with the latest version.
How do I explain to my hospital administrators the role of a clinical physicist in supporting clinical trials?
NRG performed and recently published a survey that demonstrates that it takes 10 physicist-hours per week to support every 9 active clinical trials. While the hours involved vary depending on the number of trials open at your institution, it's becoming clear that institutions wishing to participate in clinical trials must budget for physics time explicitly. A special thanks to those who filled out the survey!

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Comments (3)


09-12-2017 16:54 PM

1. The link provided in the answer to the question "As a physicist, how do I support clinical trials at my institution?" is broken. 2. "it takes 10 physicist-hours per week to support every 9 active clinical trials." How is the front loaded effort to get the facility credentialed for IMRT and/or SBRT and IGRT trials reflected in these 10 physicist-hours per week for every 9 clinical trials. Also, can you provide the link to the NRG survey?



09-13-2017 14:41 PM

Hello Mr. Morris - we have tested the link and do not find it to be broken. Here is the URL for the site referenced in the report: As for your other questions, I will ask Dr. Al-Hallaq to respond.

Dr. Monroe

09-20-2017 19:16 PM

The 10 hour per 9 active trials has 0.9 hrs of the total as related to credentialing efforts. Other times spent were (for example): in reading/support (2.4), supervising staff (2.4), simulation (1.2), reviewing treatment plans (1.8), and maintaining dicom servers (.6). I will inquire about a link to the survey.