1082 - Impact of Standardized Structure Templates on Violations for Radiation Plans Submitted to Co-Operative Group Clinical Trials

G. S. Gill, L. Gates, B. S. Marshall, M. L. Rose, and L. A. Jarvis; Department of Radiation Oncology and Applied Sciences, Dartmouth Cancer Center, Dartmouth Health, Lebanon, NH

Purpose/Objective(s): Co-operative group trials often have rigorous requirements for patient enrollment including quality assurance (QA) for individual radiation treatment plans. In modern radiation planning, there are many target volumes and organs-at-risk (OARs) which must be contoured on the treatment planning CT scan in order to ensure dose constraints are met. These trials often have specific yet different naming requirements for each target volume and OAR. Any deviation in naming can result in a violation requiring resubmission of the plan. Our hypothesis was that by introducing protocol-specific structure templates, we would reduce violations resulting from incorrectly named or missing structures for plans submitted for co-operative group clinical trial review. Materials/

Methods: A structure template was created in the treatment planning system for five co-operative group trials that were open and enrolling at a single institution. Use of the trial specific structure template was mandated for all subsequent patient enrolled in those trials. The date of structure template creation was used as the date of intervention. The number of violations occurring prior to and after the creation of the structure template were compared by calculating odds ratios with corresponding confidence intervals and p values using statistical software.
Results: There were 19 violations in 83 plans submitted across 5 co-operative group trials. Of these 19 violations, 14 were naming violations, 4 were incorrectly entered digital data submission information forms, and 1 violation was for a plan exceeding the total number of allowed positive lymph nodes in the boost volume. The percentage of violations decreased from 54% to 9% and plans submitted after the intervention had a 92% decrease in likelihood of having any violation (OR: 0.082, 95% CI 0.02-0.31, p<0.001). The percentage of naming violations decreased from 38% to 7% and plans submitted after the intervention had an 88% decrease in likelihood of having a naming violation (OR: 0.12, 95% CI 0.03-0.50, p<0.001). Table 1: Violations Pre and Post Structure Template Implementation
Conclusion: Implementation of structure templates led to a significant decrease in the likelihood of violations in radiation plans submitted to cooperative group trials, potentially improving overall plan quality and decreasing workload.

	Plans	Violations	Percent Plans with Violations	Naming Violations	Percent Plans with Naming Violations
Total	83	19	23%	14	17%
Pre Structure Template	26	14	54%	10	38%
Post Structure Template	57	5	9%	4	7%