Enhancing safety and quality through preplanning peer review for patients undergoing stereotactic body radiation therapy

Abstract

PurposeBecause of its high dose per fraction delivery, stereotactic body radiation therapy (SBRT) requires real-time process assurance to promote safe, high-quality treatments. In an effort to assure safety and first-time quality, we instituted a pilot, single-institution, SBRT peer review process before treatment planning. Here, we present a summary of the results of that process over a 26-month period. Methods and MaterialsBefore planning, all patients were presented at an SBRT “rounds” that required, at a minimum, the treating attending or resident physician, an independent attending physician, a physicist, and a dosimetrist. Items reviewed included imaging, image registration, target contours, prescription, and planning goals. The results of peer review were prospectively recorded and logistic regression models were used to assess the relationship between various physician and case characteristics and the odds of a change being made. ResultsA total of 513 SBRT cases were peer reviewed before planning. In 22.6% of cases, at least 1 change was made because of this process. A lower change rate was observed in higher volume SBRT body sites (lung and liver). In all body sites, gross and planning target volume contours were changed 8.2% and 5.5% of the time, respectively. The prescription was changed 4.9% of the time, and organs at risk goals were changed 7.2% of the time. The odds of having a change were significantly lower when the treating oncologist had more SBRT experience. ConclusionsPreplanning peer review by an independent physician, physicist, and dosimetrist resulted in changes in nearly one-quarter of SBRT patients, potentially preventing suboptimal treatments. The odds of a change being required were decreased in higher volume body sites and when the treating oncologist was more experienced with SBRT, underscoring the potential importance of peer review in uncommon SBRT sites and at low-volume SBRT centers.