Patient Safety

PV QA 3 - Poster Viewing Q&A 3

TU_28_3083 - Community Radiation Oncology Rapid Contouring Quality Assurance and Case Review: 6 month Experience

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Community Radiation Oncology Rapid Contouring Quality Assurance and Case Review: 6 month Experience
J. M. Schuster1, G. M. Cooley Jr1, A. K. Olson1, J. Duelge Jr2, and B. Y. Durkee3; 1University of Wisconsin, Madison, WI, 2Medical College of Wisconsin, Milwaukee, WI, 3Stanford Cancer Institute, Stanford, CA

Purpose/Objective(s): Many cancer patients in the United States are treated by community radiation oncologists (CRO) at private practice or academic center satellite sites. Patients choose these centers for convenience and assumption their cancer care will be equivalent. Unfortunately, past radiation oncology trials have shown “low volume” centers can have poor patient outcomes. We hypothesis that additional quality assurance (QA) program for CRO prior to established weekly academic main campus radiation plan review would improve CRO treatment plan quality through contour review, increased peer discussion and pooling experience particularly for less common diagnoses and create avenue for expert case review.

Materials/Methods: Four CRO physicians at 4 different clinics affiliated with academic center participated in pilot QA project. Program goals were for a secure, HIPPA compliant avenue for CRO and site specific academic main campus physicians to review contours from CT simulation imaging with simultaneous view of all imaging used to define contours and provide rapid case feedback within 24-48 hours. Cases uploaded to unique server through commercially available contouring platform and e-mail alerted other providers about QA request. Case information reviewed includes patient history, dose, fractionation, associated treatments, diagnostic imaging reviewed, planned respiratory management, details of CTV and PTV generation.

Results: 6-month initial results had 4 CRO requesting 86 cases reviewed. All request cases were reviewed by at least one CRO with 166 reviews and an average of 2.1 reviewers per case. Program initiated 11/2016. As of first 6 months, the requests were for definitive cases 85.7% with 20% Breast, 16% Prostate, 17% Lung including SBRT, 14% Head/ Neck, 4% esophagus, 8% rectal/anal, 4% lymphoma, 1% pancreas, 11% case discussion without contour review, 4% other. A total of 16.3% of case reviews prompted sharing of literature or contouring atlas and 17 cases had expert site specific academic faculty review. 22.1% of cases were recommended for consideration of change or need clarification by one or more reviewer and 17% of contours or treatment plan ultimately were changed. Common reasons for consideration of change was review GTV, increase/decrease volumes, suggestion of alterative technique.

Conclusion: Consensus from all participating CRO was program successful due to speed and easy of online review, promotion of literature driven discussions, improved confidence in contouring, and better avenue for site specific main academic campus physicians to complete detailed case review. CRO QA pilot will continue and should serve as a model for other community radiation oncology treatment centers given easy of implementation. CRO QA program allows for improved communication and pooling of experience of CRO who are faced with the challenge of caring for a diverse community cancer population and improved standardization between community sites

Author Disclosure: J.M. Schuster: None. G.M. Cooley: None. A.K. Olson: None. J. Duelge: None.

Jessica Schuster, MD

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