Quality and access – Early experience of implementing a virtual stereotactic chart round across a national network

Abstract

Introduction Stereotactic radiation therapy is a highly specialised technique which requires careful and structured implementation. As part of a national stereotactic programme implementation, protocols were developed and a national stereotactic chart round was formed, which strongly recommended attendance and presentation of all cases before treatment. Herein, we describe our experiences launching a national chart round and its importance in a stereotactic programme. Method Stereotactic chart rounds were held via videoconference between July 2018 and July 2019. Data collected included attendances, patient‐related information including, diagnosis, clinical background, treatment intent, prescribed dose and fractionation and technical approach. Consensus recommendations regarding changes to treatment approaches were also recorded. Results For the 12 months recorded, there were 1126 attendances, from 144 individual attendees, across 21 locations. In total, 285 cases (237 new cases, and 48 re‐presentations) were presented by 27 radiation oncologists (ROs) from 13 different locations. From the cases presented, 65 changes were recommended from 53 patients (22.3%), including 27 (11.4%) changes to contours, 18 (7.6%) changes to dose prescription/fractionation, 9 (3.8%) changes to plan dosimetry, 1 (0.4%) changes to treatment technique and 10 (4.2%) recommendations for which stereotactic radiation therapy was not advised. A significant inverse relationship was found between frequency of recommended changes and the individual RO’s stereotactic case load (P < 0.002). Conclusion The implementation of a national stereotactic chart held via videoconference has ensured national protocol compliance across the network of locations. Furthermore, the chart rounds have allowed the entire multidisciplinary team to be provided with mentorship and guidance. Increasing number of cases presented was associated with lower rates of recommended changes highlighting the impact of experience and the need for continued mentorship.

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

“…Data regarding the impact of peer review on SBRT planning are limited to two smaller cohorts from time periods in which SBRT utilisation was less frequent, and another more recent cohort of 285 cases. [10][11][12] Suggested plan changes from peer review are variably reported in the literature, but commonly are categorised as major changes which require repeat planning and minor changes which do not. [13][14][15][16] A previous review found that suggested plan changes occur in 10% of all cases, with higher rates of change observed for stereotactic radiotherapy and several specific cancer subsites.…”

“…10 A report of stereotactic radiotherapy cases in Australia found suggested plan changes in 22.3% of cases, though the rate of implementation of changes was unclear. 12 A 2015 singleinstitution study of 513 SBRT cases found that changes were implemented in 22.6% of cases, with lower rates of change in higher-volume subsites including liver (18%) and lung (17%) cases. 11 The proportion of suggested changes which were not implemented was not reported.…”

Optimization of transmural care by implementation of an online expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases: A prospective analysis

“…Several forms of hybrid MDTs have, however, been studied, mostly using videoconferencing for reasons of convenience or geography. 23,[33][34][35][36][37][38][39][40] These meetings require multisite coordination with available technology at all sites. 39 Moreover, expertise is often not available on demand, as these (bi-) weekly meetings need to be scheduled ahead to ensure simultaneous presence of key members.…”

Radiation oncology peer review in Australia and New Zealand

“…Icon Cancer Centre reported their experience with virtual national stereotactic chart rounds held across Australia and New Zealand via videoconference. 32 Twenty-one radiation oncology facilities were credentialed to increase the availability of stereotactic treatment and ensure consistent practice, education and positive clinical outcomes. An increasing number of yearly cases presented per radiation oncologist (RO) were associated with lower rates of recommended changes.…”

“…In Australia and internationally, peer review has been reported to improve patient care both directly and indirectly and be feasible within radiation oncology facilities 6–35 . The American Society for Radiation Oncology (ASTRO) surveyed members in 2013 to establish peer review practice patterns, 36 with the majority of the 572 participating physicians supporting formal recommendation and guidance on peer review.…”