Radiation Oncologist Peer Review of Breast Radiation Treatment Plans: Too Much or Never Enough?

Abstract

This study retrospectively analyzes the data collected by the breast disease site peer review program at the Juravinski Cancer Centre (JCC) between 2010 and 2016. In so doing, researchers seek to identify improvements that can be made to current breast disease site peer review protocol, and comment on the feasibility of adjusting the number of breast plans receiving peer review at the Centre. Data was obtained from an electronic database available at the JCC. This database exists as a Microsoft Excel file, and contains the findings and outcomes associated with breast disease site peer review. Results were subjected to univariate, multivariate, and thematic forms of analysis. Analysis revealed a total of 2,302 breast cases receiving peer review at the JCC between 2010 and 2016. Of these, 216 (9.4% of plans) deviated from the treatment standards defined by the Centre. Interestingly, only one of these variances (0.04% of plans) was significant enough to warrant plan modification. A declining variance rate was also noted over the course of 2010 – 2016. Studying this trend, a greater number of four-field plans were found to be associated with variance when compared to their tangential counterpart. Data was also subjected to 2x2 chi-square tests which revealed a total of 15 relationships existing amongst peer review variables. Lastly, thematic analysis was employed to review written radiation oncologist (RO) comments included in the electronic database available at the JCC. This led to the identification of three major themes: RO comments pertinent to coverage, dosimetry, and technical/machine issues. Results were inconclusive in determining whether current breast disease site peer review practices can be adjusted at the JCC. Although findings seem to indicate that a reduction in the number of breast plans receiving peer review may be feasible, further research is required to determine how the Centre should approach this initiative.