Disease-Site Specific Peer Review Implementation: From Chart Rounds to the Treatment Couch

The impact of disease site-specific peer review on radiation treatment planning recommendations is not well understood. We implemented a standardized peer review checklist to evaluate factors influencing recommendations and their implementation during disease site-specific peer review.

A 7-item checklist was completed prospectively during weekly or biweekly meetings in 4 disease site-specific peer review groups, including (1) radiation approach, (2) dose/fractionation, (3) prescription accuracy, (4) organ-at-risk contours, (5) target volumes, (6) plan quality evaluations, and (7) setup imaging. Review comments were divided into (A) education/discussion without change recommendation, (B) minor suggestion/optional modifications, or (C) major comment requiring plan modification. Rates of comment types and implementation of plan changes were tracked. Statistical analysis was conducted using the 2-proportion Z-test, Welch's t-tests, and analysis of variance.

A total of 1311 peer reviews in 914 unique patients were recorded over 6 months. The average review duration was 2 minutes 32 seconds, with significant differences across disease site groups (P < .01). There were 286 total comments: 259 (21.8%) were category A, 26 (2%) were category B, and 1 (<1%) was category C. The proportion of cases generating comments varied by disease site (10%-34%), with only a subset resulting in implemented plan changes (0%-25.8% of comments). Most implemented changes involved target volumes, organ-at-risk contours, and patient setup. Cases undergoing multiple reviews were more likely to generate comments than cases with a single review (25.0% vs 13.0%, P < .01). Furthermore, cases with multiple reviews were significantly more likely to have implemented plan changes compared with single-review cases (28.9% vs 1.2%, P < .01).

We successfully implemented a peer review checklist in the context of disease site-specific peer review meetings. There is significant variability in comments and their implementation across checklist items and disease site groups. Iterative review significantly increased the probability of treatment plan changes.