One of the primary objectives of QRRO is to assess the quality of care in radiation oncology as practiced in the United States. In 2007–2008, QRRO initiated a series of institutional surveys to evaluate the quality of treatment delivery for prostate, lung, cervix, and breast cancers based on the on-site evaluation of available treatment records. As the quality of prostate brachytherapy is essentially assessed primarily through the evaluation of the postimplantation CT scans, PLX-4720 concentration QRRO initiated an elaborate

QA process to independently reevaluate the postimplantation scans and reanalyze the dosimetric parameters that are surrogates for quality and adequacy of the dose delivery to the prostate

and normal tissues for patients treated with permanent interstitial implantation. In addition to reevaluation of the dosimetric parameters, this process would PS-341 price allow comparison of the submitted evaluation to the evaluation performed by an independent expert reviewer. Our report indicates that this QA evaluation is feasible and may serve as an opportunity for larger-scale QA assessments of individual institutions practicing prostate brachytherapy. For this report, we evaluated brachytherapy quality of treatment delivery via a web-based remote deidentification program that facilitated scans being transferred to a central depository (ITC) to allow external review from a single referee institution. The latter reevaluation process entailed 2-hydroxyphytanoyl-CoA lyase recontouring and reassessing the dosimetric outcomes of the electronically transferred postimplantation CT scans. This exercise

also afforded us the opportunity to compare dosimetric outcomes as submitted by the treating institution based on their internal QA review to that performed by the referee institution. The successful implementation of a central QA review has important implications not only for gauging the quality of brachytherapy as performed in the United States but also as a tool to provide external feedback and evaluate improvement of an individual’s performance over time through serial assessments performed in a consistent fashion. Such a process has been used in the past for centralized review of eligibility of an institution; the presence of basic skills for performing implantation can be verified, to allow for institutional eligibility to enroll patients into prospective cooperative group studies (10). This process could be integrated in the future as part of self-assessment exercises for individual institutions to evaluate the quality of their procedures performed compared with other practicing centers. Merrick et al. (11) have previously reported the dosimetric analysis of a large multiinstitutional database consisting of 6600 prostate implantation procedures performed by 129 brachytherapists from community practices.