Administered by the American College of Radiology

RT Credentialing Forms


Radiotherapy Credentialing Forms

This page includes links to forms and information required as part of the credentialing process.

New Participating Site Demographics Form 

Research sites participating for the first time in a National Clinical Trials Network (NCTN) trial that includes radiotherapy are required to complete the "New Participating Site Demographics Form." The Web-based form gathers information about a site's NCTN group affiliation and site specific info such as personnel, radiotherapy machines and treatment planning computers. Note: Form completion is require prior to a site activating a trial that includes radiotherapy. Also, the NCTN group conducting the trial may have additional activation requirements. 

Site Demographics Form

Dose Delivery Evaluation
The IROC Houston QA Center evaluates the planning and dose delivery of radiotherapy treatment with intensity modulated radiotherapy (IMRT) and other dynamic therapies using heterogeneous, anthropomorphic phantoms as a quality assurance tool for tumor dose delivery verification.  A phantom is shipped to a research site where RT personnel conduct imaging procedures, prepare a treatment plan, and deliver the plan to the phantom. The phantom is then returned to IROC Houston where the dosimeters are removed and analyzed.

Phantom Request Form

Proton Therapy Approval

Prior to enrolling patients on an NCI-sponsored trial protocol utilizing proton radiotherapy, a research site must first gain approval for use of this technology.

Proton Therapy Approval Requirements