Evaluating the Impact of Transitioning from Weekly to Daily Peer Review in Radiation Oncology

Peer review is essential for quality assurance (QA) in radiation therapy, addressing the variability among clinicians in defining treatment target volumes. At our institution, weekly peer review meetings (PRMs) were initially conducted on Fridays, but the need for more robust review led to the implementation of PRMs on a daily basis. These daily sessions aim to enhance quality by routinely discussing each radiation therapy plan with a team of radiation oncologists.

In this study, the impact of daily PRMs on radiation oncology planning was assessed by analyzing changes suggested during these meetings. Treatment plans for 249 patients were reviewed from April to September 2022. During PRMs, each plan was reviewed and modifications were categorized as no change, minor change, major change, or missing contour, with further stratification by target volumes, treatment field, radiation doses and treatment decisions.

A total of 249 cases were reviewed. The largest proportion of discussed plans comprised head & neck cancers (n= 79, 31.7%), thorax (n=55, 22.1%) followed by brain and pelvis (each n=39, 15.7%). Most of the plans i.e., 190 (76.3%) were based on IMRT/VMAT.  PRM changes were suggested in 114 (45.7%) cases, where 78 (31.3%) were minor and 36 (14.5%) were major changes. In most cases the changes were suggested in CTV i.e., 62 (24.9%) while PTV modifications were suggested in 21 (8.4%) of the cases during PRM discussion. Among all, head and neck was the region with most frequent PRM changes, suggestions 53 (57.6%) followed by pelvis 18 (19.5%).

Peer review is a vital component of quality assurance in radiation oncology, helping to identify and correct potential errors, standardize care, and enhance patient safety. It also promotes multidisciplinary collaboration and serves as a valuable educational tool, ultimately supporting more effective and individualized treatment.