# Core-funded radiotherapy trials infrastructure with central quality assurance

Source: https://onco.cc/ideas/idea-fund-radiotherapy-trials-infrastructure/  
OnCo record `idea-fund-radiotherapy-trials-infrastructure` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy trials need physicists to check every plan and central review of every target drawn, which nobody pays for. Fund that infrastructure permanently so trials are faster and results are trustworthy.

## Summary

A national or international radiotherapy trials infrastructure providing centralised contouring review, plan quality assurance, dosimetry audit, imaging and outcome data platforms and statistical support to academic radiotherapy trials, with core funding rather than per-trial grants. The UK's RTTQA group and CTRad, NRG's IROC and EORTC's RTQA show the model; their capacity limits how many trials can run. Quality assurance is the difference between radiotherapy trials that change practice (CHHiP, PACE, FAST-Forward) and those that fail from protocol deviation, which has measurably worsened outcomes in several past trials.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Core-funded QA infrastructure doubles the number of randomised radiotherapy trials opening per year in participating countries and reduces major protocol deviations to under 5% of plans, with trials reaching target accrual on time in most cases.
- Rationale: The TROG 02.02 head and neck trial showed that poor plan quality erased the treatment effect; conversely, hypofractionation trials with strong QA changed global practice within a few years of publication. Radiotherapy has produced some of the highest-value trials in oncology per dollar; the constraint is infrastructure capacity.
- Proposed test: Fund infrastructure for one country for four years with throughput targets; compare trials opened, deviation rates and time to accrual with the preceding four years.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- NRG Oncology: https://www.nrgoncology.org/
- ESTRO: https://www.estro.org/

## Connected records

- ideas: [A coordinated FLASH radiotherapy evidence programme with shared dose-rate standards](https://onco.cc/ideas/idea-fund-flash-evidence-programme/), [A neutral platform trial for radiotherapy plus immunotherapy combinations](https://onco.cc/ideas/idea-fund-rt-io-platform/), [A regulatory pathway for new radiotherapy techniques modelled on drug development](https://onco.cc/ideas/idea-fund-radiotherapy-innovation-pathway/), [A statutory minimum share of public trial money for surgery and radiotherapy](https://onco.cc/ideas/idea-fund-non-drug-trial-quota/), [Pay per course of radiotherapy, not per session, so short courses are not penalised](https://onco.cc/ideas/idea-fund-course-based-radiotherapy-payment/), [Validate and reimburse AI contouring and planning to expand radiotherapy capacity](https://onco.cc/ideas/idea-fund-rt-planning-ai-capacity/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MR-guided adaptive radiotherapy](https://onco.cc/technologies/mr-linac/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- companies: [NRG Oncology](https://onco.cc/companies/nrg-oncology/)
- institutions: [Heidelberg University Hospital / NCT / DKFZ](https://onco.cc/institutions/heidelberg-nct/), [The Christie NHS Foundation Trust](https://onco.cc/institutions/the-christie/), [The Institute of Cancer Research](https://onco.cc/institutions/icr-london/)
- people: [Ananya Choudhury](https://onco.cc/people/ananya-choudhury/), [Michael Baumann](https://onco.cc/people/michael-baumann/), [Uwe Oelfke](https://onco.cc/people/uwe-oelfke/)
- bottlenecks: [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)

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