Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre

Lymberiou, Timothy; Galuszka, Susanne; Lee, Grace; Xu, Wei; Fyles, Anthony; Su, Susie; Purdie, Thomas G.; Catton, Pamela; Chung, Caroline; Dinniwell, Robert; Koch, Anne; Levin, Wilfred; Manchul, L.; Warde, Padraig; Liu, Fei‐Fei

doi:10.1016/j.radonc.2014.11.042

Cited by 22 publications

(16 citation statements)

References 32 publications

(41 reference statements)

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“…Consequently, when a single CSRT completed the contouring across 600+ patients with H&N cancer, contouring consistency was significantly increased . Furthermore, introducing QA “case rounds” resulted in an opportunity to discuss planning variations and achieve team consensus . Similarly, another CSRT assumed responsibility for QA rounds for a breast disease‐site group and was able to increase the number of patient cases reviewed from 20 to 100% .…”

Section: Resultsmentioning

confidence: 99%

“…22,23 Similarly, another CSRT assumed responsibility for QA rounds for a breast disease-site group and was able to increase the number of patient cases reviewed from 20 to 100%. 23 Another CSRT developed new institutional guidelines for whole brain radiation, reducing the large variation in techniques that previously existed. 22 Due to QA changes implemented by CSRTs, there has been a substantial increase in standardization of treatment and consistency in practice, which is expected to lead to more accurate dose delivery and better outcomes for patients.…”

Section: Activities Further Along the Patient Care Pathwaymentioning

confidence: 99%

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The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada

Harnett

Lockhart

Ang

et al. 2018

J of Medical Radiation Sci

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IntroductionThe Clinical Specialist Radiation Therapist (CSRT), is a new advanced practice (AP) role for radiation therapists (RTTs). Following training, education and evaluation, the CSRT performs specific duties in autonomous ways, making advanced clinical decisions in their area of specialization. This case study examines the CSRT's impact on quantity (i.e., increasing capacity), improving quality and stimulating research and innovation.MethodsBetween 2007 and 2016, 23 CSRTs worked in 10 cancer centres in various AP position. A standardised metrics package, focusing on wait‐times, patient volumes, patient throughput, time‐savings, quality initiatives, satisfaction, research and innovation was developed and used to collect qualitative and quantitative data. Data were self‐reported by the CSRTs but electronic databases, pre/post‐studies, surveys and interviews were also used.ResultsQuantity projects (n = 76) related to patient volumes, wait‐times, patient throughput and time‐savings increased capacity and allowed more patients to enter the system. The presence of a CSRT allowed, on average, 13 additional patients (either new or re‐treated) to be seen, at their respective cancer centre, per month. An average of 1.4 yearly quality improvement initiatives were led by each CSRT, which contributed to improvements in quality of care and satisfaction. CSRTs demonstrated a high level of involvement in research, innovation and knowledge translation activities, either as leaders or part of interprofessional teams.ConclusionCSRTs positively impact quantity (capacity of the system), quality, research and innovation. Future efforts include permanent and sustainable team integration, practice standards, formal and comprehensive educational preparation, and approaches to consistent, valid assessment of AP in radiation therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Activities Further Along the Patient Care Pathwaymentioning

confidence: 99%

The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada

Harnett

Lockhart

Ang

et al. 2018

J of Medical Radiation Sci

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“…Table 1 is a summary of these articles describing peer review meeting structure and processes. Of the 17 articles, most were from centres in the USA (n ¼ 10, 58.8%) [14,15,18,20,21,25e27,29,30], followed by Canada (n ¼ 3, 17.6%) [19,23,24]; the UK (n ¼ 3, 17.6%) [17,22,28] and Australia (n ¼ 1, 5.5%) [16].…”

Section: Resultsmentioning

confidence: 99%

Structure and Processes of Existing Practice in Radiotherapy Peer Review: A Systematic Review of the Literature

et al. 2021

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Peer review in radiotherapy is an essential step in clinical quality assurance to avoid planning-related errors that can impact on patient safety and treatment outcomes. Despite recommendations that radiotherapy centres should include peer review in their regular quality assurance pathway, adoption of the practice has not been universal, and to date there have been no formal guidelines set out to standardise the process. We undertook a systematic review of the literature to determine existing practice in radiotherapy peer review internationally, with respect to meeting structure and processes, in order to define a standardised framework. A PubMed and Web of Science search identified 17 articles detailing peer review practice. The results revealed significant variation in peer review processes between institutions, and a lack of consensus on documentation and reporting. Variations in the grading of outcomes of peer review were also noted. Taking into account the results of this review, a framework for standardising the process and outcome documentation for peer review has been developed. This can be utilised by radiotherapy centres introducing or updating peer review practice, and can facilitate meaningful evaluation of the clinical impact of peer review in the future.

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“…Following on from this, Lymberiou et al [18] showed that from 2223 breast radiation plans analyzed 4.4% required major changes while Rouette et al [15] identified a rate change of 41.5% for left/right breast plans and 30.8% for left/right chest wall. Both studies noticed that plans involving the regional lymph nodes were more likely to have recommended changes suggesting that cases with locoregional nodal involvement should be a significant area of focus for peer review.…”

Section: Discussionmentioning

confidence: 98%

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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Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre

Cited by 22 publications

References 32 publications

The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada

The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada

Structure and Processes of Existing Practice in Radiotherapy Peer Review: A Systematic Review of the Literature

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

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