A Prospective Analysis of Radiation Oncologist Compliance With Early Peer Review Recommendations

Walburn, Tyler; Wang, Kyle; Sud, Shivani; Zakrzewski, Alexandra; Roehm, Robyn; Sutton, Stephanie R.; Tan, Xianming; Adams, Robert D.; Mazur, Łukasz; Marks, Lawrence B.; Chera, Bhishamjit S.

doi:10.1016/j.ijrobp.2019.02.036

Cited by 21 publications

(31 citation statements)

References 20 publications

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“…Previous studies identified similar proportions of recommended plan changes after peer review, accounting for 23.3 [6] [14] and 27% [11] respectively. In addition, some reviews also included changes in total dose (16.4%) or fractionation (6.8%) [6] that did not resulted in re-planning and a total minor change rate of 37 [11], 12.9 [12],7.3 [14] and 47.8% [15] respectively, which is in alignment with the 11.5% rate of minor changes obtained at our institution. Accordingly to a survey of North American teaching centers, 75% of respondents estimated that major changes occurred in < 10% whilst minor changes were estimated to be requested in < 10% of cases by 61% of respondents [5].…”

Section: Discussionmentioning

confidence: 72%

“…Arising from our experience, peer-review process brings to light unperceived considerations or additional viewpoints that could lead to changes resulting in the outcome of radiation plans that otherwise would not have been made without this process. The degree of compliance with peerreview recommendations arising from Walburn et al [11] was reasonably good (59%) but it decreased as recommendation magnitude increased: 65% for minor and 47% for major recommendations respectively, suggesting that early rather than late peer review may enhance compliance and efficiency creating a safety-oriented culture. Moreover, Rouette et al [15] reported a rate of 38.5% of major changes for plans presented after treatment had begun.…”

Section: Discussionmentioning

confidence: 94%

“…Other institutions have a dual-layer process with both early and late peer review evaluating different aspects. In addition, centers perform either prospective peer review (before radiation) or once the therapy has started (inside the first week) and mostly discuss only cases considered complex [2,3,6,11]. According to RD 1566/1988 [17], items such as treatment indication, contouring, isodoses, DVH and not expected reactions should be discussed in departmental clinical sessions.…”

Section: Discussionmentioning

confidence: 99%

“…One limitation is the low sample of plans compiled (148) compared to other publications with thousands [11,13,15,26]. As we revise all cases, data collected represents an assortment of pathologies treated at our institution during a whole month period and, even though we assume it is not accurate to extrapolate results, we believe it gives the reader an idea of the amount of cases and disease's locations presented during a year (1701 EBRT cases in 2019).…”

Section: Discussionmentioning

confidence: 99%

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100% peer review in radiation oncology: is it feasible?

et al. 2020

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Purpose Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. Methods and materials Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. Results Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-trainingphysicians and one physicist. Median time per session was 38 (4-72) minutes. 59.5% of cases presented in 1-4 min, 32.4% in 5-9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). Conclusion Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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100% peer review in radiation oncology: is it feasible?

et al. 2020

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“…Several studies report that the frequency of recommendations/modifications of treatment plans ranges from ~10% to 40%, with the frequency being higher when peer review is done pretreatment. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Not only is the willingness to make changes, or even recommend them, lower at late peer review, but the risk associated with rushed work to replan creates its own set of issues for error-free treatment. 14 The horse is already out of the barn, so to speak.…”

mentioning

confidence: 99%

Restructuring Our Approach to Peer Review: A Critical Need to Improve the Quality and Safety of Radiation Therapy

Chera¹,

Potters²,

Marks³

2020

Practical Radiation Oncology

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Chart rounds with peer review has long been a standard (some would say historical) practice in radiation oncology, and generally has been a feasible and effective quality control tool. Within radiation oncology, chart rounds remains a requirement by the American Society for Radiation Oncology, American College of Radiology, and the American Association of Physicists in Medicine. 1 Chart rounds with peer review commonly is a weekly meeting where treatment plans of patients who are in their first week of treatment are peer reviewed; that is, a retrospective quality control measure. The effectiveness of this approach has never been prospectively assessed.In this issue of Practical Radiation Oncology, Talcott et al from the Yale School of Medicine, Department of Therapeutic Radiology report "A Blinded, Prospective Study of Error Detection During Physician Chart Rounds in Radiation Oncology" to address this knowledge gap. 2 Twenty treatment plans with simulated errors were covertly presented at their weekly chart rounds over 9 weeks. The types of errors were selected from the Radiation Oncology Incident Learning System database and thus were realistic (eg, wrong target identified, normal structures not spared, inadequate target coverage, dose/fractionation pattern incorrect, previous treatment not considered, and problem with imaging used for planning)din other words, the usual suspects that keep us awake at night. Plus, most of the errors were designed to be "highly detectable." Only 55% of the errors were detected. This is a sobering and critically important contribution to our field, and the investigators should be commended for their work.

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Three discipline collaborative radiation therapy (3DCRT) special debate: Peer review in radiation oncology is more effective today than 20 years ago

Ahmad

Santanam

Padilla

et al. 2020

J Applied Clin Med Phys

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Radiation Oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplinesmedicine, physics, and biology. As a result, discussion of controversies or changes in practice within radiation oncology must involve input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit. 1-3 In light of these results, we endeavor here to adopt this "team-science" approach to the traditional debates featured in this journal. This article is part of a series of special debates entitled "Three Discipline Collaborative Radiation Therapy (3DCRT)" in which each debate team includes a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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A Prospective Analysis of Radiation Oncologist Compliance With Early Peer Review Recommendations

Cited by 21 publications

References 20 publications

100% peer review in radiation oncology: is it feasible?

100% peer review in radiation oncology: is it feasible?

Restructuring Our Approach to Peer Review: A Critical Need to Improve the Quality and Safety of Radiation Therapy

Three discipline collaborative radiation therapy (3DCRT) special debate: Peer review in radiation oncology is more effective today than 20 years ago

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