The CTO Streamlined Research Ethics Review System (CTO Stream) is a streamlined approach to research ethics review that supports a single, qualified REB (the REB of Record) in providing research ethics review and oversight for multiple participating sites. All studies use the same interface and REB application forms, irrespective of which REB is pending oversight.
When to Use CTO Stream?
Any multi-centre clinical trial or observational study involving two or more academic institutions/public health care institutions (academic hospitals, community hospitals, universities) in Ontario.
- List of participating sites posted on CTO website
- Call CTO if there is a site you do not see on the website
- Private clinics/physician offices are not currently part of the CTO system
Terms at a Glance:
Observational Study - In an observational study, researchers assess health outcomes in groups of participants according to a research plan or protocol. Participants are not prospectively assigned to receive specific interventions by the researcher (as in a clinical trial). For example, in an observational study, researchers may observe a group of adults to learn more about the effects of different lifestyles on cardiac health.
Clinical Trial - In a clinical trial, participants receive specific interventions according to the research plan or protocol created by the researchers.
Participating Institutions:
For a complete list of participating institutions, please click here.



