Prospective Peer Review in Radiation Oncology: Analysis of Protocol Deviations at a Large Multi-Center Institution to Improve Patient Safety.

Abstract

Introduction: Peer review is essential for radiation therapy quality assurance (RTQA) and recent studies show that peer review upstream of treatment planning is feasible and can improve radiation therapy quality. Herein, we describe protocol deviations detected by our peer review process by the type of deviation, disease site, and physician characteristics.

Materials/methods: Once contoured, cases within our department undergo prospective peer review with each case assigned a grade (A, B, or C). "A" cases require no changes, while "B" and "C" cases have protocol deviations requiring minor or major modification, respectively, prior to treatment planning. We reviewed all radiation cases with curative intent from 2017-2022. We analyzed cases receiving a B score by type of protocol deviation, disease site, and physician characteristics. The two-proportion Z-test was performed to determine differences in the proportion of B scores.

Results: 13,091 curative cases underwent peer review across our institution; 58.6% of cases received an "A", 41.3% received a "B", 0.1% received a "C". Common errors in cases receiving a B score were a mismatch between the prescription and directive (34.2%) or a deviation in the planning target volume (32.8%). The disease sites that accounted for the largest volume of all B scores were head and neck (20.2%), prostate (13.2%), breast (9.1%), and lung (7.9%). Generalists had a greater percentage of B scores compared to specialists (46.9% vs. 34.3%, p<0.0002). No significant difference in B scores was observed between tenure and non-tenure physicians (40.5% vs. 42.2%, p=0.0511).

Conclusions: Peer-review contour rounds was performed on 100% of curative cases where 41% required modification prior to treatment planning, highlighting the importance of prospective contour peer review for all patients to catch discrepancies upstream of treatment planning. Implementing peer review in radiation oncology can mitigate common deviations in RT planning, irrespective of disease site or physician expertise.