SUPREMO Selective Use of Postoperative Radiotherapy after Mastectomy / NHS Scotland

Radiotherapy Quality Assurance

There are inherent problems in making sure radiotherapy is reproducible and accurate within radiotherapy units, and when this is being done on a multi-centre basis as part of a clinical trial these problems are magnified.

A quality assurance programme is an integral part of any radiotherapy trial. In the Supremo trial, the quality assurance programme will allow us to confirm that participants have understood the technical guidelines within the protocol and implemented them correctly and that the dose prescription is delivered with appropriate documentation.

The QA programme we are using will build on that developed for the START trial, which has provided a basis for consensus among radiotherapy centres in the UK.

The QA programme will include:

  • An initial questionnaire setting out precise details of the technique to be used, together with specimen patient outlines to be used to produce ideal plans.
  • A visit by the QA team or a series of software phantoms to be planned and measured to test the planning system algorithm. This should be completed prior to a centre entering patients in the study. Centres who have already had dosimetry for chest wall irradiation independently verified for the equipment currently being used will not need to perform this test.
  • Approximately 1 in 10 patients in the UK will have TLD sent from the QA team for in vivo dosimetry. These patients will be identified at randomisation. If possible this will also be extended to centres outside of the UK
  • The QA team will then collect 1 in 10 plans to make sure the protocol is being followed.
  • Centres participating in the cardiac study should send copies of radiation port films and central axis treatment plan or CT plans for all patients, for centralised documentation. We prefer these to be sent electronically.

The data from the quality assurance programme will be analysed separately from the main trial. You will be notified of any major discrepancies.

To find out more about the QA Programme and to download the Supremo RT QA questionnaire, please visit, or if you are having problems with this, please visit the mirror on this site. The radiotherapy quality assurance for Supremo is being overseen by Dr Edwin Aird, Mount Vernon Hospital, Northwood and further details can be obtained from Dr Karen Venables or Mahathi Govindu at or Coen Hurkmans (EORTC RT QA co-ordinator) at

The below letter details some important modifications to the RTQA programme:
Supremo RT QA - Dose prescription modification  Download word document [28kb]

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