Evaluation of Peer Review Practice in Radiation Oncology Treatment Planning: Single Institution Experience

Abstract

Pretreatment Peer review meeting at our radiation oncology department is a weekly meeting, where the initial radiation treatment (RT) planning process for every patient is discussed including: Computed Tomography (CT) simulation and treatment planning. In this study, we are aiming to evaluate our peer review process and to report the compliance to the suggested modifications. All RT plans for all patients indicated for radiotherapy accepted by the primary radiation oncology team then presented in our weekly peer review meeting for final approval. A minimum of two radiation oncologists reviewed each plan and their suggestions documented then suggested modifications are classified as changes in: field arrangement, clinical target volume (CTV), dose and fractionation. Compliance to suggested modification also recorded as: applied and not applied with or without documented justification. Atotal of 1779 radiation treatment plans were discussed in our regular weekly peer review meetings for a period of 3 years. 67.5% of them were treated with radical intent while 32.5% treated with palliative intent. The most common technique used was three-dimensional conformal (3DCRT) followed by intensity modulated RT (IMRT) (70.6% and 29.4%, respectively). The most frequently reviewed sites were: breast (38%), Gastrointestinal (11.9%) and head and neck (9.3%).1592 plans (89.48%) were labeled as: approved, 162 (9.1%) labeled as: modified and only 25 (1.4%) plans labeled as: hold. The frequency of modifications was significantly greater in breast (39.5%) than Gastrointestinal (17.9%) followed by gynecological cancers (14.2%) (P value <0.001). Modifications were more predominant with radical plans (64.2%) than palliative ones (35.8%) (P value <0.001) and statistically greater using 3DCRT (64.2%) than IMRT (35.8%) (P value <0.001). CTV recorded as the most frequent variable suggested for modifications (34.6%), followed by dose and fractionation (24.7%) (P value = 0.035). 72.2% of recommended modifications were applied by the consultant of primary team and 22.2% of non-applied modifications were justified and documented. There was 100% compliance rate to all plans labeled as hold. The practiceof peer review in radiation oncology specialty is very challenging. Its role in quality assurance of the radiotherapy process is highly accepted by radiation oncologists at our radiation oncology department. It is reflected in their high compliance rate to the suggested modifications. We recommend its implementation routinely at any radiation oncology department to enhance the quality of RT plans.