Streamlining the radiotherapy practice through multidisciplinary peer review rounds: An initial 4-year experience from an Indian radiotherapy department.

Abstract

Aim and background: Multidisciplinary peer review is a proven and effective quality control method in radiotherapy. This study reports and analyzes the impact of the peer review rounds of a modern radiotherapy department during the first 4 years.

Subjects and methods: Prospectively documented data for 183 peer review sessions consisting of 3725 patients from June 2017 to May 2021 were obtained. The proportion of cases that required major (unacceptable and requires an immediate correction before delivery) and minor plan changes (not ideal, but still allowable for delivery) were analyzed on a site-specific basis. Pareto charts were plotted for each site to demonstrate the reasons for plan changes.

Results: Among the cases reviewed, 197 plans (5.29%) required any plan modifications; among these, 111 (2.98%) were major changes, while 86 (2.31%) cases required minor changes. The major changes suggested had decreased from 5.84% to 1.58% over time. The reasons for plan changes were site dependent. Frequent reasons for major plan change were modification in clinical target volume (63.06%), followed by a change in dose or fractionation (24.32%). Minor plan changes were mainly due to changes in normal tissue contour or dose (32.56%), followed by field port or MLCs (23.26%).

Conclusions: Adherence to peer review practices since the establishment of the department has led to a considerable reduction in plan modifications with time as a result of consistent improvement in the radiotherapy processes.