CREDENTIALING FOR PROTOCOLS
This questionnaire will help determine if your institution is credentialed to participate in a protocol.
IROC Houston will notify you and the study group of your status.
The study group or IROC Houston will inform your institution when it can participate in the requested protocol.
If you have any questions, please contact IROC Houston at (713) 745-8989 or
IROC-Credentialing@MDAnderson.org
Please note:
You will be contacted via email or phone within 2 business days. Once we determine that all requirements are met, a credentialing email (PDF letter for a few protocols) will be issued within 5 business days.
Institution:
?
Study Group Name:
ACOSOG
ACRIN
Alliance
CALGB
CCTG
COG
COMS
CTSU
ECOG
ECOG-ACRIN
GOG
NCCTG
NCORP
NRG
NSABP
RTOG
SWOG
RTF#: (Don't know, click
here
)
NCI #:
Select RTF# or NCI# , or both.
Name of person completing this form:
?
Phone #:
?
Email address:
?
Please enter correct email address.
Are you a:
Radiation Oncologist
Physicist
Dosimetrist
Clinic Coordinator
Protocol to be credentialed:
Provide the RTF# for the radiation facility if different from above
RTF#: (Don't know, click
here
)
Specify technique:
3DCRT
IMRT
SBRT
Proton
Brachytherapy
Treatment planning system to be used for this protocol:
Algorithm to be used for patient plans:
Is your institution planning to use
IGRT
on this protocol,
if applicable?
Yes
No
Is your institution planning to use
4DCT
on this protocol,
if applicable?
Yes
No
For randomized photon vs. proton protocols, please list the RTF# of your partner proton center: (Don't know, click
here
)