Current practices in peer review in German radiation oncology: a nationwide survey

Clinical peer review (PR) is a structured process in which medical professionals evaluate the quality of their colleagues' work to ensure compliance with healthcare standards. In radiation oncology (RO), intra-institutional PR has become established as a key quality assurance (QA) measure to improve treatment safety and effectiveness. While various guidelines and recommendations exist internationally, no uniform PR framework for radiation treatment decision-making and planning has been defined in Germany.

This study aims to provide an overview of current PR practices in German RO departments, assess the degree of implementation of recommended PR measures, and identify areas for improvement.

A digital survey among RO specialists was conducted from January 7 to February 7, 2025. The survey included structured questions on PR implementation, participation of different professional groups, timing, documentation, and technological infrastructure. Free-text fields allowed for additional insights. The collected data were analyzed descriptively.

A total of 51 complete questionnaires-mainly from academic centers-were evaluated. Here, PR was widely implemented, particularly involving physicians and medical physicists, with 86% of departments performing case discussions and 82% PR of plans before the first radiation session. Most participants reported that PR effectively supports treatment planning and safety. However, PR for target delineation and image fusion was only implemented in 41% of cases. The inclusion of RTTs, nurses, and radiologists was rare. Documentation of PR processes, particularly attendance tracking and implementation of recommended changes, was inconsistent. Time constraints, personnel shortages, and high patient volume were the most frequently reported barriers to continuous PR.

While PR seems to be an integral part of radiation therapy in Germany, its structure and implementation throughout centers need to be elucidated. While some aspects, such as pre-therapeutic PR, are well established in our cohort, gaps remain in the integration of multidisciplinary teams, structured documentation, and contouring reviews. Further discussions within the German RO community and the development of national recommendations could help to standardize PR processes and improve their efficiency and effectiveness.