Physician Body-Site Expertise and Stereotactic Radiosurgery/Stereotactic Body Radiation Therapy Rounds Review

Contouring targets for stereotactic body radiation therapy (SBRT) requires expertise for each body site. Likewise, peer reviewers require sufficient expertise to provide an adequate review. In this work, we investigate physician self-reported expertise for performing peer review by body site and how the quality of SBRT peer review is impacted by the expertise of the reviewer.

The results of 7 years of SBRT rounds, which included information on body site, attending and reviewing physicians, changes to targets, prescriptions, and planning target volume, were analyzed. We surveyed physicians on their expertise for reviewing each body site and defined them as being an expert by body site if they indicated a moderate or high level of competence. Multivariable logistic regression models were used to assess the association between reviewing physician expertise and planning data changes, and whether this varied by body site or by presenting physician expertise. Models were adjusted for physician and case characteristics, and generalized estimating equations were used to account for the correlation of cases reviewed by the same physician.

The survey response rate was 95% (20/21) with 4103 cases for analysis. Reviewing physician experts were more likely to make any change, gross target volume, and prescription compared with reviewing physicians who were nonexperts. Controlling for physician expertise and case characteristics, brain, liver, spine, and stereotactic radiosurgery cases have an increased odds of any change being made when compared to lung cases, with odds ratios of 2.42 (95% CI, 1.78-3.30), 1.55 (95% CI, 1.19-2.01), 1.7 (95% CI, 1.31-2.20), and 2.18 (95% CI, 1.73-2.77), respectively.

The extent to which changes are made during contour review is associated with both peer reviewer disease-site expertise and disease site. In larger radiation oncology departments relying on a general coverage model, rather than review by disease-site experts, peer review results in variations in the outcome of the preplanning review.