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BACKGROUND Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance with frequent repeat treatments. There is evidence that the quality of the initial surgical procedure (Transurethral resection of bladder tumour (TURBT)) and timely administration of postoperative bladder chemotherapy significantly reduces cancer recurrence rates and improves outcomes such as cancer progression and mortality. There is some survey-based evidence that TURBT practice varies significantly across surgeons and sites1. There is evidence from clinical trials that NMIBC recurrence rate varies significantly between sites and that this cannot be accounted for by differences in patient, tumour, or adjuvant treatment factors, suggesting that how the surgery is performed may be a reason for the variation. OBJECTIVE This study primarily aims to determine if feedback of and education about surgical quality indicators can improve performance, and secondarily if this can reduce cancer recurrence rates. METHODS This study is an observational, international, multi-centre study with an embedded cluster randomised trial of audit, feedback, and education. Sites will be included if they perform TURBT for NMIBC. RESULTS The study has 4 co-primary outcomes which are 4 TURBT quality indicators: a surgical performance factor; an adjuvant treatment factor; and two documentation factors. A key secondary outcome is the early cancer recurrence rate. CONCLUSIONS Local and/or national ethical and institutional approvals or exemptions will be obtained at each participating site. The study results will be published in peer-reviewed journals and presented at national and international scientific congresses. CLINICALTRIAL The study is registered with clinicaltrials.org (NCT05154084).

Objectives To determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort. Patients and methods A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site. Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis. Results A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39). Conclusions Continuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.

Context The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. Objective To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. Evidence acquisition A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. Evidence synthesis Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients’ mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. Conclusions The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. Patient summary The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward., Take Home Message The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold, or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

Background: Diabetes mellitus has been identified as a serious global public health concern. Diabetic foot disease is one of four major complications that impacts on people with the disease and health systems. The majority of diabetic foot care, including screening and treatment, occurs in the primary care sector. To provide optimal care, evidence-based guidance is essential for all healthcare professionals. There is little known about the implementation of these guidelines in primary care settings. The aim of this scoping review will be to identify strategic components used to support the implementation of diabetic foot disease evidence-based practice guidelines by healthcare professionals in primary care. Methods: A scoping review drawing on methods and guidance from the Joanna Briggs Institute will be conducted and will be reported according to the PRISMA-ScR Checklist. This study will retrieve literature on strategic components used to implement diabetic foot disease evidence-based practice guidelines by health professionals in primary care, through a comprehensive search strategy in the following databases: CINAHL; Medline (Ovid); Embase; the Cochrane Library; and PsycINFO. Grey literature will be searched within the references of identified articles and in Lenus, BASE and LILACS. A data charting form will be developed with categories including: article details, population demographics, implementation strategies, strategy details, and evaluation methods such as feasibility and effectiveness, duration of intervention and duration of follow up. Conclusions: Promoting foot care for people with diabetes in the primary care setting can make a significant impact on overall outcomes for the person and the health service. However, without the transition of evidence-based guidelines to practice, the impact can be difficult to assess. This study will map the evidence that can assist the transfer of evidence-based practice guidelines for diabetic foot care to healthcare professionals in primary care.

International variations in the rates of kidney cancer (KC) are considerable. An understanding of the risk factors for KC development is necessary to generate opportunities to reduce its incidence through prevention and surveillance.To retrieve and summarize global incidence and mortality rates of KC and risk factors associated with its development, and to describe known familial syndromes and genetic alterations that represent biologic risk factors.A systematic review was conducted via Medline (PubMed) and Scopus to include meta-analyses, reviews, and original studies regarding renal cell carcinoma, epidemiology, and risk factors.Our narrative review provides a detailed analysis of KC incidence and mortality, with significant variations across time, geography, and sex. In particular, while KC incidence has continued to increase, mortality models have leveled off. Among the many risk factors, hypertension, obesity, and smoking are the most well established. The emergence of new genetic data coupled with observational data allows for integrated management and surveillance strategies for KC care.KC incidence and mortality rates vary significantly by geography, sex, and age. Associations of the development of KC with modifiable and fixed risk factors such as obesity, hypertension, smoking, and chronic kidney disease (CKD)/end-stage kidney disease (ESKD) are well described. Recent advances in the genetic characterization of these cancers have led to a better understanding of the germline and somatic mutations that predispose patients to KC development, with potential for identification of therapeutic targets that may improve outcomes for these at-risk patients.We reviewed evidence on the occurrence of kidney cancer (KC) around the world. Currently, the main avoidable causes are smoking, obesity, and high blood pressure. Although other risk factors also contribute, prevention and treatment of these three factors provide the best opportunities to reduce the risk of developing KC at present.

Complex surgery associated with major hemorrhage presents particular risks for Jehovah's Witnesses who do not accept transfusion of blood products. Intraoperative use of two cell saver machines simultaneously can maximize the yield of salvaged blood from both the operative field and from washed surgical swabs and can potentially be life‐saving.

Society has witnessed a rapid increase in the adoption of commercial uses of emotion recognition. Tools that were traditionally used by domain experts are now being used by individuals who are often unaware of the technology’s limitations and may use them in potentially harmful settings. The change in scale and agency, paired with gaps in regulation, urge the research community to rethink how we design, position, implement and ultimately deploy emotion recognition to anticipate and minimize potential risks. To help understand the current ecosystem of applied emotion recognition, this work provides an overview of some of the most frequent commercial applications and identifies some of the potential sources of harm. Informed by these, we then propose 12 guidelines for systematically assessing and reducing the risks presented by emotion recognition applications. These guidelines can help identify potential misuses and inform future deployments of emotion recognition.

OBJECTIVES To evaluate contemporary oncological outcomes and long-term survival in patients undergoing surgery for urological tumours involving the peridiaphragmatic inferior vena cava up to the level of the right atrium. To apply prognostic factors developed for metastatic renal cancer to patients with very-high-risk but apparently localized tumours, and develop a scoring system. PATIENTS AND METHODS A retrospective cohort study of 54 patients referred between December 2007 and April 2018 to a single surgical and oncological team was conducted. Electronic patient records were used to obtain peri-operative data and oncological follow-up. For operated patients lost to follow-up, survival data were obtained from primary care physicians. We used Kaplan-Meier curves to estimate overall survival (OS) and disease-free survival. For the subgroup undergoing curative surgery (n = 32) the prognostic value of a renal cancer score developed at Guy's Hospital using five of the six criteria in the International Metastatic Renal Cell Carcinoma Database Consortium prognostic model (one point for each of anaemia, neutrophilia, thrombophilia, hypercalcaemia and Karnofsky performance status

This article focuses on seven interacting research‐informed domains. These domains are grounded in the research literature and have been applied in real world contexts to provide insight into, and an analytical tool for, meeting social, emotional and mental health (SEMH) needs within educational settings. Practitioner researchers applied the domains in a ten‐month knowledge‐exchange programme known as SWERL. Each domain is described in relation to the lived experience of teachers, pupils and schools. The article closes with a case study of how a primary school changed SEMH provision in the areas of 'planning transitions' and 'building relationships' and illuminates the benefits for children, staff and school culture. [ABSTRACT FROM AUTHOR]

It has been demonstrated that publication of individual surgeons' outcomes has improved patient safety and choice. Taking into consideration the lack of negative impact on patient selection and surgical training, it is difficult to argue that surgeons' outcomes should not be openly available in urology.

Geofence search warrants, also known as reverse location search warrants, are a new, digital version of the general warrants, or “writs of assistance”, that were at the heart of the Fourth Amendment’s inclusion in the Bill of Rights. Fourth Amendment jurisprudence has been consistently challenged for over a century in the face of technology advancements such as the wiretap, computers, the internet, and mobile phones. But the challenge posed by geofence warrants, in which the government can demand that private sector technology providers disclose a list of mobile devices in a defined place at a defined time, may be the Fourth Amendment’s most vexing encounter yet. When combined with protections provided by the Stored Communications Act, enacted in 1986, it positions the courts as a porous last line of defense between government intrusion and expectations of privacy in the mobile device era. This Article explains why this situation is perilous, and describes the widening gap between existing Fourth Amendment jurisprudence and rapidly advancing technology to obtain, aggregate, and correlate data about citizens, both anonymous and uniquely identifying, to surveil and profile the public, with a focus on geofence warrants as this era’s emblematic investigative tool. This Article will explain why anonymization is a weak safeguard and argue for more stringent requirements to bring judicial domain knowledge in line with that of law enforcement officers, who have greater access to specialized training in digital forensics. Lastly, the Article will discuss needed reforms to current statutory protections that no longer possess the ability to constrain government intrusion into our daily lives. The judiciary and legislatures place checks on one another, but both are quickly being left behind by technology advances, big data, and private sector inclusion in modern law enforcement.

ADAPTeR is a prospective, phase II study of nivolumab (anti-PD-1) in 15 treatment-naive patients (115 multiregion tumor samples) with metastatic clear cell renal cell carcinoma (ccRCC) aiming to understand the mechanism underpinning therapeutic response. Genomic analyses show no correlation between tumor molecular features and response, whereas ccRCC-specific human endogenous retrovirus expression indirectly correlates with clinical response. T cell receptor (TCR) analysis reveals a significantly higher number of expanded TCR clones pre-treatment in responders suggesting pre-existing immunity. Maintenance of highly similar clusters of TCRs post-treatment predict response, suggesting ongoing antigen engagement and survival of families of T cells likely recognizing the same antigens. In responders, nivolumab-bound CD8+ T cells are expanded and express GZMK/B. Our data suggest nivolumab drives both maintenance and replacement of previously expanded T cell clones, but only maintenance correlates with response. We hypothesize that maintenance and boosting of a pre-existing response is a key element of anti-PD-1 mode of action.

BackgroundContracting COVID-19 peri-operatively has been associated with a mortality rate as high as 23%, making prevention vital.ObjectivesThe primary objective is to determine safety of surgical admissions and procedures during the height of the COVID-19 pandemic using ‘hot’ and ‘cold’ sites. The secondary objective is to determine risk factors of contracting COVID-19.Design, Setting and ParticipantsA retrospective cohort study of all consecutive patients admitted from 1st March – 31st May 2020 at a high-volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a ‘cold’ site requiring a negative COVID-19 swab 72 hours prior to admission and to self-isolate for 14 days pre-operatively, whilst all acute admissions were admitted to the ‘hot’ site.Outcome Measurements and Statistical AnalysisComplications related to COVID-19 were presented as percentages. Risk factors for developing COVID-19 infection were determined using multivariate logistic regression analysis.Results and LimitationsA total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the urology team; 101 (16.5%) on the ‘cold’ site and 510 (83.5%) on the ‘hot’ site. Procedures were performed in 495 patients of which 8 (1.6%) contracted COVID-19 post-operatively with 1 (0.2%) post-operative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with 2 (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). Limitations include possible under reporting due to post-operative patients presenting elsewhere.ConclusionsContinuation of surgical procedures using ‘hot’ and ‘cold’ sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a post-operative mortality.Patient SummaryUsing ‘hot’ and ‘cold’ sites has allowed the safe continuation of urological practice throughout the height of the COVID-19 pandemic.

Aim To systematically review the natural history of crouch gait in bilateral cerebral palsy (CP) in the absence of surgical intervention and to review any relationship between clinical variables and progression of knee crouch. Methods Relevant literature was identified by searching article databases (PubMed, CINAHL, EMBASE, and Web of Science). Included studies reported on participants with bilateral CP who had 3-dimensional gait analysis on at least two occasions with no surgical interventions between analyses. Results Five papers (4 retrospective cohort studies; 1 case report) comprised the final selection. Studies varied in follow-up times and participant numbers. Increased knee flexion over time was reported in the four retrospective studies with two distinct patterns of increasing knee flexion evident. Only the case-study reported improved knee extension between assessments. Four studies demonstrated increased hamstring tightness over time with the biggest increases related to longer follow-up time rather than increase in crouch. Conclusion and Implications The existing literature suggests that the natural history of crouch gait is towards increasing knee flexion over time. Future prospective studies of bigger groups are needed to examine the relationship between increasing crouch and clinical variables.

OBJECTIVES: To report on the contemporary UK experience of surgical management of renal oncocytomas. SUBJECTS AND METHODS: Descriptive analysis of practice and postoperative outcomes of cases with a final histological diagnosis of oncocytoma included in The British Association of Urological Surgeons (BAUS) nephrectomy registry from 01/01/2013 to 31/12/2016. Short term outcomes were assessed over a follow-up of 30 days. RESULTS: Over 4 years, 32130 renal surgical cases were recorded in the UK, of which 1202 were oncocytomas (3.7%). Most patients were male (n=756; 63.3%), the median age was 66.8 years (interquartile range (IQR) 13). Median lesion size was 4.1cm (IQR 3; range 1-25cm), 43.5% were ≤4cm and 34.2% were 4 to 7cm lesions. Thirty-five patients (2.9%) had preoperative renal tumour biopsy. The majority of patients had minimally invasive surgery, either radical (n=683; 56.8%), partial nephrectomy (n=483; 40.2%) or other procedures (n=36; 3%). One in five (n=253; 20.2%) patients had in-hospital complications: 48 were Clavien-Dindo classification grade III or above (4% of total cohort), including 3 deaths. Two additional deaths occurred within 60 days of surgery. The analysis is limited by the study's observational nature, not capturing lesions on surveillance or ablated after biopsy, possible underreporting, short follow-up, and lack of central histology review. CONCLUSION: We report on the largest surgical series of renal oncocytomas. In the UK, the complication rate associated with surgical removal of a renal oncocytoma was not negligible. Centralisation of specialist services and increased utilisation of biopsy may inform management, reduce overtreatment, and change patient outcomes for this benign tumour. This article is protected by copyright. All rights reserved.

Objective: The objective of this study is to evaluate the utility of routine loopogram follow-up three months after cystectomy and urinary diversion in the early detection of benign ureteroileal anastomotic stricture (UAS). Materials and methods: A loopogram was incorporated into our standard follow-up three months after cystectomy and conduit urinary diversion in August 2010–December 2015. Data were maintained prospectively in a database. Results: A total of 250 patients (181 male; 69 female); median age of 70 years (range: 38–83) underwent cystectomy and conduit urinary diversion during this period. Of these, 167 (66.8%) had a routine loopogram at three months. Seven of 167 were confirmed to have a benign UAS. Twenty-three of 250 (9.2%) had an early loopogram prior to the planned three-month study in response to symptoms. Nine of 23 were diagnosed with benign UAS. Sixty of 250 (24%) did not have a routine loopogram for a variety of reasons. Five patients with normal three-month loopograms developed late strictures after a median time of 22 months (range 5–38). In total 21/250 (8.4%) patients developed UAS. Stricture rates for the open, robotic and laparoscopic modalities were 8/129 (6.2%), 12/111 (10.8%) and 1/10 (10%) respectively. Five of seven of patients with early, asymptomatic UAS diagnosed on routine loopogram received treatment; four of five had improvement in renal function. Conclusion: Overall stricture rate in this series was 8.4%. The majority of UAS occur early and are more likely to be symptomatic. A policy of routine loopogram benefitted only 4/250 (1.6%) patients. We advocate the use of loopograms in cases with a high index of suspicion rather than for routine screening. Level of evidence: Not applicable for this multicentre audit.

Background Increased loading at the lumbar spine, particularly in the coronal plane, has been reported in children with cerebral palsy (CP). As pelvic and trunk movements associated with Trendelenburg and Duchenne type gait are most significant in the coronal plane, the potential exists for lower lumbar spinal loading to be negatively affected in children with CP and these types of movement patterns. Objective The objective of this study was to assess trunk and pelvic kinematics and lower lumbar spinal loading patterns in children with CP and Trendelenburg and Duchenne type gait. Design This was a cross-sectional study. Methods Three-dimensional kinematic (lower limb and thorax) and L5-S1 kinetic data were recorded. Children were divided according to clinical presentation of Trendelenburg or Duchenne type gait. Several discrete kinematic and kinetic parameters were assessed between groups. Results Three distinct pelvic and trunk movement patterns were identified for children with CP: Trendelenburg, Duchenne, and complex Trendelenburg–Duchenne. Peak L5-S1 lateral bending moments were increased by 62% in children with CP and Duchenne type gait. Children with CP and complex Trendelenburg-Duchenne gait demonstrated the largest deviations from normal, with increased peak ipsilateral and contralateral directed moments of 69% and 54%, respectively, compared with children with typical development. Limitations A test-retest reliability analysis or measure of minimal detectable change was not conducted as part of this study. Results suggest that measures of minimal detectable change may be high for some of the reported variables. In addition, the inverse dynamic approach determines only the net intersegmental reactive forces that reflect the effect of external loads. Previous studies have shown that spinal loads may be larger than the net intersegmental force. Conclusions Trendelenburg and Duchenne type movements were not always distinct, and a third type of movement, a combination of the two, was the most common in this study. Clinicians should be aware that children with CP and the Duchenne type or the complex Trendelenburg-Duchenne type of gait pattern experience abnormal loading that may have significant implications for the lower spine in the long term.

The increasing pervasiveness of algorithmic tools in criminal justice has led to an increase in research, legal scholarship, and escalating scrutiny of automated approaches to consequential decision making. A key element of examination in literature focuses on racial bias in algorithmic risk assessment tools and the correlation to higher likelihoods of high bail amounts and/or pretrial detention. These two phenomena combine to initiate a cascading effect of increased likelihoods for conviction, incarceration, harsher sentencing, higher custody levels, and barriers to parole, leading to negative impacts on other factors unrelated to criminal history, all of which feed into subsequent assessment instruments for defendants who are re-arrested. This escalating cascade of algorithmic bias errors has particularly dire consequences for Black defendants, who are statistically more likely to receive higher failure-to-appear (FTA) and recidivism risk scores than white defendants, and who are thus more likely to be negatively impacted by subsequent decisions, both human and computer-aided, throughout the criminal justice process. This is periodically referred to in literature as ‘disparate impact’ but lacks a deeper examination of broad-based effects. This Article endeavors to advance that examination by looking across multiple elements of criminal procedure and beyond to aid in understanding cascading effects and consequent injustices suffered by Black defendants due to the continued automation and encoding of societal biases into the criminal justice process.

In 2010/3, the Large Area Telescope on board Fermi revealed a transient gamma-ray source, positionally coincident with the optical nova in the symbiotic binary, V407Cyg. This event marked the first discovery of gamma-ray emission from a nova. We aimed to obtain resolved radio imaging of the material involved in the nova event; to determine the ejecta geometry and advance velocity directly in the image plane; to constrain the physical conditions of the system. We observed the source with the EVN and the VLBA over 16 epochs, between 20 days and 6 months after the optical discovery. The source is initially very dim but it later shows a substantial increase in brightness and a resolved shell-like structure 40 to 90 days after the optical event. The shell has a projected elliptical shape and is asymmetric in brightness and spectral index, being brighter and characterised by a rising spectrum at the S-E edge. We determine a projected velocity of ~3500 km/s in the initial phase, and ~2100 km/s between day 20 and 91. We also found an emitting feature about 350 mas (940 AU) to the N-W, advancing at a projected velocity of ~700 km/s along the polar axis of the binary. The total flux density in the VLBI images is significantly lower than that previously reported at similar epochs and over much wider angular scales with the VLA. Optical spectra demonstrated that in 2010 we were viewing V407Cyg along the equatorial plane and from behind the Mira. Our radio observations image the bipolar flow of the ejecta perpendicular to the orbital plane, where deceleration is much lower than through the equatorial plane probed by the truncated profile of optical emission lines. The separated polar knot at 350 mas and the bipolar flow strictly resemble the similar arrangement seen in Hen 2-104. The observed ~700 km/s expansion constrains the launch-date of the polar knot around 2004. [Abridged], Comment: Accepted for publication in A&A; 18 pages, 11 figures

Aims: The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history ofprostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial.Materials and methods: The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localized prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n ¼ 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era.Results: There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outliningreview showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of theprostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints inProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent.Conclusion: The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. 2016 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.