Development of a Comprehensive, Contour-Based, Peer Review Workflow at a Community Proton Center

Area of Science:

• Radiation Oncology
• Medical Physics
• Quality Improvement

Background:

• Quality assurance is crucial in radiation oncology, especially with advanced conformal treatments like proton therapy.
• Proton therapy offers precise dose delivery but requires specialized knowledge for optimal outcomes and toxicity reduction.

Purpose of the Study:

• To develop and implement a comprehensive peer review program for a community-based proton therapy center.
• To enhance the quality of care provided to patients undergoing proton therapy.

Main Methods:

• A prospective peer review policy was established for all patients starting January 2013.
• Daily prospective case reviews for treatment appropriateness and biweekly reviews of contouring and treatment plans were conducted.

Main Results:

• Over a 6-month period, 223 new patients were treated, with 99.6% having peer review documentation.
• Biweekly sessions reviewed an average of 10.7 cases, with contour and plan reviews taking approximately 145 and 120 seconds, respectively.
• Modifications were suggested for 7.9% of contour reviews and 6.4% of treatment plan reviews.

Conclusions:

• A comprehensive, prospective peer review program is feasible in a community proton therapy setting.
• This program serves as a model for establishing future quality assurance initiatives in proton therapy centers.