Patient Safety

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TU_27_3079 - Adding Value to Physician Peer Review of External Beam Treatment Plans

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

Adding Value to Physician Peer Review of External Beam Treatment Plans
A. W. Greener, C. Breen, and M. D. Kelly; VA New Jersey Health Care System, East Orange, NJ

Purpose/Objective(s): Radiation Oncology professional societies recommend individual physician peer review as part of a Quality Improvement Program. The American College of Radiology (ACR) recommends that case-specific peer review should be performed by another radiation oncologist(s) on a weekly basis. (1) The review should include at a minimum a presentation of new patients and give attention to indications for radiation therapy, target definition, and dose. The American Association of Physicists in Medicine (AAPM) also recommends new patient planning conferences attended by radiation oncologists, radiation therapists, dosimetrists and medical physicists. (2) These standards are also used for program accreditation. (3,4,5) The objective of this study is to report findings of contour, field and plan review as part of weekly physician peer review conference.

Materials/Methods: As part of our quality improvement program, contour, field and plan review was included in our weekly physician peer review conferences. Each external beam (EBRT) case was independently reviewed by a staff radiation oncologist in a conference format with radiation oncologists, medical physicist(s), dosimetrist(s), radiation therapist(s) and radiation oncology nurse(s) in attendance. In most cases, contours and fields were reviewed after simulation and before the final treatment plan. Treatment plans were reviewed before the first treatment or during the first week of treatment.

Results: During 2017, 205 EBRT cases (52% IMRT, 8% SBRT, 40% other) were reviewed. Seventy-four (36.1%) cases received comments from the reviewing radiation oncologist. In 44.6% of the cases, the comments were given only during contour/field review, 41.9% received comments only during plan review and 13.5% during both contour/field and plan reviews. Comments resulted in contours modified for 29 cases, fields modified for 6 cases, and dose or fractionation modified for 7 cases. Only 10 (4.9%) of all EBRT cases reviewed needed a new plan. Eight out of 10 of these cases were IMRT, which required more time and effort resulting in a possible delay in treatment. Twenty-seven cases had comments that did not result in any change, but added value to the case.

Conclusion: A physician peer review of all EBRT patients was found to be very useful in providing quality care to our patients with minimal time commitment from the radiation oncologists. Having the contour/field review after simulation and before the treatment plan is completed, has resulted in <5% replan rate for all EBRT cases. If only plan review was incorporated, then an estimated 20% of the EBRT treatment plans would be suboptimal and in need of a change once the patient starts treatment.

Author Disclosure: A.W. Greener: Independent Contractor; VA new Jersey Health Care System. C. Breen: None. M.D. Kelly: President; American Association for Women Radiologists.

Anne Greener, PhD


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