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Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and

Yew Sin1, Vikneswary Batumalai2,3, Jeremy de Leon2

  • 1University of Notre Dame Australia, School of Medicine, Fremantle, Western Australia, Australia.

Clinical and Translational Radiation Oncology
|August 12, 2024
PubMed
Abstract

Insights

Peer review significantly impacts magnetic resonance (MR) guided radiotherapy (MRgRT) plans, with 36.4% of cases requiring changes. This process is crucial for quality assurance, especially for stereotactic body radiation therapy (SBRT) and reirradiation cases.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Quality Assurance in Healthcare

Background:

  • Peer review is a cornerstone of quality assurance in radiotherapy.
  • No prior studies have assessed the feasibility and outcomes of peer review for MR-guided radiotherapy (MRgRT) on MR linear accelerators (MR-Linacs).
  • MRgRT planning is complex and its clinical applications are expanding.

Purpose of the Study:

  • To quantify the rate of treatment plan changes following peer review in MRgRT.
  • To determine the time and resources required for the MRgRT peer review process.
  • To evaluate the impact of peer review on MR-Linac treatment plans.

Main Methods:

  • Prospective collection of 55 MR-Linac cases over 15 weeks (June-September 2023) across two institutions.
  • Analysis of treatment plans using the Peer Review Audit Tool for radiation oncology (PRAT).
  • Assessment of plan changes, focusing on organs at risk (OAR) volumes, dose, and target coverage.

Main Results:

  • 36.4% of MRgRT treatment plans required modifications post-peer review.
  • Major changes necessitating treatment deferral occurred in 3.6% of cases.
  • Frequent changes involved OAR delineation/sparing (16.4%), dose/fractionation (10.9%), and target dose coverage (5.5%).
  • Higher change rates were observed for SBRT, oligometastatic/oligoprogressive sites, and reirradiation cases.
  • Mean discussion time per case was 7 minutes.

Conclusions:

  • The high rate of plan modifications underscores the value of peer review in MRgRT.
  • Peer review is recommended for all MRgRT cases, particularly SBRT, oligometastatic/oligoprogressive, and reirradiation scenarios.
  • Implementing peer review enhances the quality and safety of MRgRT.
Keywords:
Adaptive radiotherapyMR-guided radiotherapyMR-linacPeer ReviewQuality assuranceRadiation OncologyRadiotherapyReirradiationStereotactic ablative body radiation therapy

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