Prospective analysis of radiation oncology image and plan-driven peer review for head and neck cancer

Departmental "chart rounds" is an established form of review in radiation oncology, however, evidence is lacking that identifies links between features of a more subspecialized disease site-specific review and the likelihood and characteristics of recommendations made. We prospectively analyzed our head and neck group's review process to identify associations that could guide future practice.

Our group reviewed proposed management and treatment volumes for radiation simulated patients on a weekly basis, and we collected data encompassing recommendations made by individuals or group consensus.

Changes in management, prescribed dose, radiation fractionation, clinical target volumes, or target contours were suggested in 85 of 182 cases. The most frequently recommended changes were adjustment of regions treated or target contours, and an inverse correlation was observed between the number of attending physicians present and specific changes suggested to the gross tumor volume (GTV).

We find that site-specific head and neck peer review results in frequent recommendations largely independent of the type of case reviewed.