Peer review quality assurance in stereotactic body radiotherapy planning: the impact of case volume

Abstract

Purpose: Peer review is an essential quality assurance component of radiation therapy planning. A growing body of literature has demonstrated substantial rates of suggested plan changes resulting from peer review. There remains a paucity of data on the impact of peer review rounds for stereotactic body radiation therapy (SBRT). We therefore aim to evaluate the outcomes of peer review in this specific patient cohort. Methods and materials: We conducted a retrospective review of all SBRT cases that underwent peer review from July 2015 to June 2018 at a single institution. Weekly peer review rounds are grouped according to cancer subsite and attended by radiation oncologists, medical physicists and medical radiation technologists. We prospectively compiled ‘learning moments’, defined as cases with suggested changes or where an educational discussion occurred beyond routine management, and critical errors, defined as errors which could alter clinical outcomes, recorded prospectively during peer review. Plan changes implemented after peer review were documented. Results: Nine hundred thirty-four SBRT cases were included. The most common treatment sites were lung (518, 55%), liver (196, 21%) and spine (119, 13%). Learning moments were identified in 161 cases (17%) and translated into plan changes in 28 cases (3%). Two critical errors (0.2%) were identified: an inadequate planning target volume margin and an incorrect image set used for contouring. There was a statistically significantly higher rate of learning moments for lower-volume SBRT sites (defined as ≤30 cases/year) versus higher-volume SBRT sites (29% vs 16%, respectively; p = 0.001). Conclusions: Peer review for SBRT cases revealed a low rate of critical errors, but did result in implemented plan changes in 3% of cases, and either educational discussion or suggestions of plan changes in 17% of cases. All SBRT sites appear to benefit from peer review, though lower-volume sites may require particular attention.

Guidelines for safe practice of stereotactic body (ablative) radiation therapy: RANZCR 2023 update

“…Higher volume caseloads have been shown to reduce changes recommended in peer-review chart rounds. 31,40 Recommendations for minimum caseloads to maintain expertise in SABR have ranged from 10 to 25 procedures per year. 8,14,15 In the Australian setting, a minimum caseload of 12 procedures per body site per year has been described to maintain credentialing of individual RO.…”

“…Maintenance of expertise should be demonstrated through minimum caseload of body site specific experience, continued professional development and regular participation in the peer‐review process. Higher volume caseloads have been shown to reduce changes recommended in peer‐review chart rounds 31,40 . Recommendations for minimum caseloads to maintain expertise in SABR have ranged from 10 to 25 procedures per year 8,14,15 .…”