Improving Quality Metrics in Radiation Oncology: Implementation of Pre-Treatment Peer Review for Stereotactic Body Radiation Therapy in Thoracic Cancer Patients

Abstract

<h3>Purpose/Objective(s)</h3> Traditional peer reviews occur weekly and can take place up to one week after treatment start. The ASTRO peer review white paper identified stereotactic body radiation treatments (SBRT) as high priority for contour/plan review prior to treatment start, considering both the rapid dose-falloff and short treatment course. Yet, peer review goals for SBRT must also balance physician time demands and the desire to avoid treatment delay. Here, we report our pilot experience of a pre-treatment (pre-Tx) peer review of thoracic SBRT cases. <h3>Materials/Methods</h3> Starting 03/2020, patients undergoing thoracic SBRT were identified for pre-Tx review by radiation therapists and placed on a quality checklist. We implemented twice-weekly peer review meetings for faculty and residents to perform detailed pre-treatment review of OAR/target contours and dose constraints in the treatment planning system with other faculty, and dosimetry/physics representation when available. We analyzed aspects of this transition over an 18-month period, and divided timepoints into monthly intervals for comparison. Our quality metric goal was to peer review ≥90% of SBRT cases before 25% of the dose is delivered. We used statistical process control to assess review patterns over the course of pre-treatment review implementation. <h3>Results</h3> We identified 252 unique patients treated with SBRT to 294 lung nodules. When comparing monthly pre-Tx review scheduling and pre-Tx review completion from initial rollout to full implementation <b>(Table 1, column 1 and 2)</b> we found at least 2 months where implementation was outside the two-sigma limit (96.99% and 78.55%, respectively), indicating a sustained shift in the process control chart. Additionally, completion of any form of contour/plan review before 25% of the SBRT dose was delivered increased from 67-85% (03/2020-11/2020), to 94% (06/2021-08/2021) <b>(Table 1, column 4)</b>. This met our quality improvement objective. <h3>Conclusion</h3> We successfully implemented a sustainable workflow for detailed pre-Tx contour/plan review for thoracic SBRT cases in the context of twice-weekly disease site-specific peer review meetings without incurring treatment delays. In the future, we plan to investigate the impact of pre-treatment review on clinical parameters e.g., the rate of minor and major changes to a radiation plan.