Practical Radiation Oncology最新文献

{"title":"The Secret Story of Leopold Freund: Pioneering Radiation Scientist and Nazi Victim.","authors":"Franziska Eckert","doi":"10.1016/j.prro.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.prro.2025.02.003","url":null,"abstract":"","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Consensus Guidelines on the Delineation of Radiation Therapy Target Volumes for Nasopharyngeal Carcinoma After Induction Chemotherapy Using a 2-Round Modified Delphi Survey.","authors":"Nejla Fourati, Warren Bacorro, Omar Nouri, Ryan Anthony Agas, Audrey Larnaudie, Lester Bryan Co, Hela Hammami, Clevelinda Calma, Melvin L K Chua, Chong Zhao, Jamel Daoud, Michael Benedict Mejia","doi":"10.1016/j.prro.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.prro.2025.01.015","url":null,"abstract":"<p><strong>Purpose: </strong>Induction chemotherapy (ICT), a new standard in the management of locally advanced nasopharyngeal carcinoma (NPC), is increasingly used in endemic regions. Radiation therapy (RT) target volume delineation protocols and dose level prescriptions vary significantly in the literature. High-level evidence to support a particular approach is currently lacking. We developed an international consensus guideline toward harmonizing practices based on a literature review and expert opinion.</p><p><strong>Methods and materials: </strong>The study entailed the following: consensus scope definition by focus group discussion (FGD); evidence gap identification by a scoping review of guidelines and literature reviews; evidence review and synthesis by a systematic review of experimental and observational studies and drafting of consensus statements by FGD; and consensus voting by modified Delphi process and FGD. The task force consisted of radiation oncologists from intermediate- and high-endemicity regions with expertise in treating NPC, evidence review, and consensus guideline development. The consensus panel consisted of relevant specialists from intermediate- and high-endemicity regions or with expertise in treating NPC. A modified e-Delphi method was used.</p><p><strong>Results: </strong>Four clinical situations after ICT for patients with NPC were selected for the consensus questions: optimal timing of chemoradiation; optimal imaging modalities for simulation and target volume delineation; optimal dose and fractionation; and RT target volume delineation. The consensus panel consisted of radiation oncologists (12), clinical oncologists (4), radiologists (3), a nuclear medicine specialist, medical physicists (2), and dosimetrists (2). The consensus guidelines were formulated after 2 rounds of Delphi voting and FGD; iterative revisions were made based on 2 rounds of internal review. The guidelines were subjected to external review and open commentary; further revisions were made if the consensus vote was not invalidated.</p><p><strong>Conclusions: </strong>An international consensus guideline on delineating RT target volumes and corresponding dose levels in post-ICT NPC, as well as timing and modalities for imaging, was developed to help harmonize practices and enhance the comparability of interpretations of reported outcomes.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"6- YEAR RESULTS FROM A PROSPECTIVE PHASE II TRIAL OF TEN-FRACTION HYPOFRACTIONATED RADIOTHERAPY IN LOCALLY ADVANCED BREAST CANCER.","authors":"P Pinnarò, S Takanen, L Marucci, V Landoni, A Soriani, C Botti, P Vici, F Sperati, D Giannarelli, G Sanguineti","doi":"10.1016/j.prro.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.prro.2025.03.002","url":null,"abstract":"<p><p>PURPOSE We report the 6-year results of a phase II study on hypofractionated radiotherapy (HFRT) targeting the primary and regional lymph nodes in ten fractions (fxs). MATERIALS AND METHODS A schedule of 34 Gy/10 fxs/2 wks to the whole breast/chest wall and to the draining lymph nodes was used. Both acute and late toxicities were collected. All pts but those who underwent mastectomy without reconstruction or with temporary expander were asked to rate their cosmetic outcome according to the Harvard scale. Toxicity was assessed weekly during RT and then at each follow-up (fup) examination. Cancer related endpoints were evaluated from the date of RT start to the diagnosis of local relapse/distant metastases or the last fup respectively. RESULTS From February 2015 to March 2019, 59 women (median age 60 yrs, IQR: 48.3-68.8 yrs) with stage II to IIIA breast cancer who underwent axillary dissection and conservative surgery (83%) or mastectomy (17%) were accrued. One patient was lost to fup immediately after the end of RT. At the median fup of 77.11 months (range: 24-102 months), the cumulative incidence of any grade loco-regional late toxicity estimated with the Kaplan-Meier method is 43.4% (95%CI) (30.0% and 46.1% for patients undergone mastectomy and lumpectomy, respectively). Peak- 2 events have been observed for fibrosis (1 pt, 1.7%), telangiectasia (1 pts, 1.7%) and lymphoedema (1 patient, 1.7%). One patient (1.7%) experienced grade 3 breast retraction at 36 month fup. The cosmetic outcome resulted to be excellent, good, fair and poor in 61.7%, 25%, 7.6% and 5.7%, respectively. At 72 months the specific-disease free survival was 96.5%; distant metastasis-free survival (DMFS) and OS rates were 88% and 94.4% respectively. CONCLUSIONS Our results support the activity of a 10-fxs Hypo-RT schedule targeting the primary site as well as the draining lymph node stations after surgery for locally advanced BC.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSMA PET in Management of Vestibular Schwannoma.","authors":"Pavnesh Kumar, Kyle Wu, Daniel Prevedello, Edward Dodson, Jana Ivanidze, Divya Yadav, Rituraj Upadhyay, Jonathan P S Knisely, Oliver Adunka, TaeLor Jones, Evan M Thomas, Raju R Raval, Sasha Beyer, Bingfeng Tang, Joshua D Palmer","doi":"10.1016/j.prro.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.prro.2025.03.004","url":null,"abstract":"<p><p>Vestibular Schwannomas (VS) are benign tumors arising from vestibulocochlear nerve Schwann cells. Single or multifractional stereotactic radiation therapy (SRT) is commonly used for treatment of these tumors and accurate target delineation is critical for the focused radiation delivery, maximizing tumor control while minimizing toxicity. Contrast-enhanced MRI is the gold standard for diagnosis, monitoring of VS and is critical in precise target delineation for SRT planning. Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) has established clinical utility for diagnosis and monitoring of prostate cancer. However other central nervous system neoplasms including VS have also been found to be PSMA tracer avid. We present the first clinical use of PSMA PET for SRT in a patient with VS who was unable to undergo MRI.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Recurrence after D2 Radical Surgery for Gastric Cancer: Implications for Postoperative Radiotherapy.","authors":"Wenheng Jiang, Haohua Wang, Xiang Zhang, Xue Dou, Kunli Zhu, Lei Xu, Yong Huang, Jinming Yu, Jinbo Yue","doi":"10.1016/j.prro.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.prro.2025.03.005","url":null,"abstract":"<p><strong>Purpose: </strong>We evaluated the role of adjuvant radiotherapy after D2 lymphadenectomy for gastric cancer, identified patients most likely to benefit from postoperative radiotherapy, and defined the optimal target volume for adjuvant radiotherapy by analyzing recurrence patterns.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,169 patients with stage I-III gastric cancer who underwent D2 surgery, of whom 225 experienced recurrence. Both overall and regional recurrences were examined, with regional recurrence patterns categorized by tumor site. Particular emphasis was placed on the vertical distribution of recurrences in lymph nodes at station no. 16. Risk factors for locoregional recurrence (LRF) were identified by using multivariate logistic regression. A predictive nomogram for LRF was developed and validated by using discrimination (area under the curve [AUC] of a receiver operating characteristic [ROC] curve) and calibration (calibration curve with bootstrap resampling).</p><p><strong>Results: </strong>The predominant pattern of single-site recurrence was peritoneal failure (29.8%), followed by distant metastasis (23.1%) and locoregional failure (20.0%). High-risk lymph node stations for regional recurrence (>10%) included nos. 7, 8, 9, 11p, 12, 13, 16a, and 16b. Although regional recurrence patterns varied by tumor location, station no. 16 consistently demonstrated the highest recurrence rate. Recurrent lymph nodes at station no. 16 exhibited a normal distribution, with about 90% estimated as being located between 6.1 cm below and 5.0 cm above the lower edge of the left renal vein. Multivariate analysis identified pathologic T category (3-4 vs. 1-2) and lymph node ratio (>25% vs. ≤25%) as independent risk factors for LRF. A predictive nomogram incorporating these factors was developed that achieved an AUC of 0.79, indicating good discrimination ability.</p><p><strong>Conclusions: </strong>This study of recurrence patterns and risk factors for LRF in patients with gastric cancer after D2 lymphadenectomy suggests a subpopulation who may benefit from adjuvant radiotherapy and offers insights for target volume definition.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Peer Review in Radiation Oncology: Analysis of Protocol Deviations at a Large Multi-Center Institution to Improve Patient Safety.","authors":"Manav Shah, Ajay Kapur, Louis Potters, Leila Tchelebi","doi":"10.1016/j.prro.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.prro.2025.03.001","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials/methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and benefits of a simplified physics direct patient care protocol.","authors":"Cassandra Kk Stambaugh, Kathryn E Huber, John Mignano, Elizabeth Meyer, Christopher S Melhus","doi":"10.1016/j.prro.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.prro.2025.02.010","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the benefits and challenges of implementing a medical physics consult program in a small clinic.</p><p><strong>Methods: </strong>A Simplified Physics Direct Patient Care (SPDPC) protocol was developed based on previously described programs. The program was streamlined to one consult with a physicist during a 30-minute time block. Non-emergent patients were offered the program on the day of external beam simulation and if they indicated interest in one of three consults (virtual, day of sim, first day of treatment) via an initial survey, they took the short form of the Spielberger State-Trait Anxiety Inventory (STAI-6). At consult, the physicist provided a brief overview of treatment planning, quality assurance, answered questions and provided a tour of the treatment room (virtual or in-person). Patients repeated the STAI-6, answered two emotional check-in and three technical satisfaction questions after the consult and then repeated the STAI-6, three technical satisfaction and one overall satisfaction question at the end of treatment.</p><p><strong>Results: </strong>The SPDPC clinical trial ran for two years. 200 patients were offered participation and 45% (n=90) enrolled. 67% chose a consult in-person on their first day of treatment. 78 patients completed the consult and 65 completed the end of treatment (EOT) survey. The anxiety score was (mean ± standard deviation) 32.1 ± 12.8 at baseline, 27.5 ± 12.0 after medical physics consult, and 26.7 ± 9.0 at the EOT. The change in mean anxiety score from enrollment to after the medical physics consult was statistically significant (p=0.0004), and the change from consult to EOT was not significant. The mean technical satisfaction score was evaluated on a 4-point Likert scale. After the medical physics consult the mean technical satisfaction score was 3.82 ± 0.51 and at EOT 3.92 ± 0.19. There was no statistically significant difference between these two time-points.</p><p><strong>Conclusion: </strong>Establishing a new clinical role for medical physicists in a small clinic can be challenging due to staffing resources and time restrictions. SPDPC protocol allows smaller clinics to provide medical physics consults, despite these challenges, while maintaining a similar positive impact to larger programs on the patient and their care experience.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical Approach to CT-Guided Online Adaptive Radiotherapy for Abdominopelvic Tumors.","authors":"David P Horowitz, Yi-Fang Wang, Albert Lee, Adam C Riegel, Jared Pasetsky, Carl Elliston, Catherine Spina, Israel Deutsch, Zahra Ghiassi-Nejad, Yading Yuan, Michael Price, Lisa A Kachnic","doi":"10.1016/j.prro.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.prro.2025.02.011","url":null,"abstract":"<p><p>Adaptive radiation therapy (ART) represents an evolution in the field of radiation oncology, addressing the complexities of tumor motion and anatomical variability that often challenge conventional treatment techniques. In abdominopelvic cancers, where the proximity of organs at risk (OARs) and variability in patient anatomy necessitate precise dose delivery, online adaptive radiation therapy (OART) has emerged as a technique to limit dose to OARs while optimizing dose delivery to target volumes. Computed tomography-guided OART is a time-efficient modality utilizes high-resolution cone beam computed tomography (CBCT) and artificial intelligence (AI) to enable real-time plan adaptation to daily anatomical changes, improving target coverage and minimizing exposure to healthy tissues. Herein, we describe the CT-based OART framework, evaluating the multidisciplinary approach and the critical role of template generation in ensuring treatment accuracy and workflow efficiency. The discussion progresses to site-specific applications, exploring the dosimetric and clinical implications of OART in gastrointestinal, genitourinary, and gynecologic cancers. Finally, the paper highlights future directions, including emerging technologies and the integration of adaptive techniques into routine clinical practice, paving the way for broader implementation of OART across various cancer types.</p>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Fraction Radiosurgical Tolerance of Brainstem, Trigeminal Nerve, and Meckel's Cave for Facial Numbness","authors":"Krishna C. Monroe ,&nbsp;Ronald L. Hammers MD ,&nbsp;Olivier C. Blasi MS ,&nbsp;Richard C. Mallory MS ,&nbsp;Alan T. Monroe MD","doi":"10.1016/j.prro.2024.08.011","DOIUrl":"10.1016/j.prro.2024.08.011","url":null,"abstract":"<div><h3>Purpose</h3><div>This article reviews toxicity outcomes for a series of patients treated with stereotactic radiosurgery for trigeminal neuralgia, focusing on dose to the brainstem, trigeminal nerve, and Meckel's cave as possible explanatory variables for the development of the most common posttreatment neuropathy, facial numbness.</div></div><div><h3>Methods and Materials</h3><div>A retrospective review of 136 cases treated with CyberKnife radiosurgery for trigeminal neuralgia was performed. Dose was initially (cohort 1) prescribed to 57 to 64 Gy covering a 6-mm cylindrical shaped target volume ≥2 mm from the dorsal root entry zone. Subsequently, a deliberate change to isocentric treatment planning occurred, resulting in delivery of 85 Gy to a spherical target (cohort 2). Brainstem, trigeminal nerve, and Meckel's cave were contoured, and a variety of dosimetric and clinical factors were analyzed for association with development of treatment-related facial numbness.</div></div><div><h3>Results</h3><div>Treatment-related numbness occurred in 59 of 136 (43%) patients and did not differ between the treatment cohorts. Fifty-two patients experienced Barrow Neurological Institute (BNI) grade II toxicity, and 7 patients experienced BNI grade III toxicity. Time to numbness was 16.0 months for cohort 1 and 10.4 months for cohort 2 (<em>P</em> = .184). The median brainstem maximum dose was 26.1 Gy, ranging from 4.2 Gy to 57.3 Gy. Maximum dose to the trigeminal nerve was 85 Gy. Mean trigeminal nerve dose was 47.3 Gy. The median Meckel's cave maximum and mean doses were 26.0 Gy and 6.8 Gy, respectively. No definitive upper limit dose threshold was detected for the structures analyzed, but trends were noted for maximum trigeminal nerve dose of 85 Gy (<em>P</em> = .083) and for prescription dose (<em>P</em> = .057) and trigeminal nerve V40 (<em>P</em> = .077) in the type I subset.</div></div><div><h3>Conclusions</h3><div>Brainstem, trigeminal nerve, and Meckel's cave tolerated doses within the range delivered. Discussion of the literature is provided to guide treatment planning and management.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e124-e130"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Patient Care Delays in Radiation Oncology Via Optimization of Insurance Preauthorization","authors":"Maxwell Tran MD ,&nbsp;Bhisham Chera MD, FASTRO ,&nbsp;Kevin Shrake MD ,&nbsp;Bradley Depaoli MD ,&nbsp;Edward Duffy III MD ,&nbsp;Michael Hall MD ,&nbsp;Justin Steinman DO ,&nbsp;Stephanie Myers MD ,&nbsp;Osagie Igiebor MD ,&nbsp;Jay Callahan ,&nbsp;Daniel McDonald MS ,&nbsp;Jennifer Harper MD ,&nbsp;Samuel Lewis Cooper MD","doi":"10.1016/j.prro.2024.10.002","DOIUrl":"10.1016/j.prro.2024.10.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Difficulties and delays in insurance preauthorization (preauth) can negatively impact patient care, resulting in postponing, modifying, or even canceling radiation therapy for patients. We aimed to perform a root cause analysis for preauth delays in our department and implement solutions to optimize our workflow. Our primary objectives were to decrease the mean time for clinical treatment plan (CTP) completion and the number of cases delayed/denied by 50% each.</div></div><div><h3>Methods and Materials</h3><div>We performed a root cause analysis for preauth delays and used the Plan, Do, Study, Act, and A3 quality improvement methods. We sampled ∼2 cases per disease site (19 cases from July to August 2022) to determine the baseline. Countermeasures included (1) optimizing our CTP templates per disease site to contain the specific clinical information required for preauth, (2) formalizing earlier completion of CTPs in our Care Path, and (3) formalizing the preauth workflow in our Care Path. We tracked various metrics, including the mean time for CTP completion, the percentage usage of our Care Path, the percentage usage of revised CTP templates, the mean time until preauth was initiated and completed, and the percentage of cases delayed/denied. Two-tailed <em>t</em> tests and χ² tests were used to generate <em>P</em> values comparing mean values and percentages, respectively.</div></div><div><h3>Results</h3><div>A total of 495 patients completed computed tomography simulation in our department between October 2022 and February 2023. The mean time for CTP completion (day 0 = day of computed tomography simulation scheduling) improved from 16 days at baseline to 4 days (<em>P</em> &lt; .001). Care Path usage improved from 16% to 97% (<em>P</em> &lt; .001), as did the usage of our revised CTP templates, from 0% to 97% (<em>P</em> &lt; .001). The mean time from insurance preauth initiation to completion improved from 5 days to 1 day. The percentage of cases that were delayed/denied was reduced significantly from 32% to 8% (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Improving timeliness and details of CTP documentation and preauth by using our Care Path and optimizing CTP templates improved the efficiency of insurance preauth completion and reduced the number of cases delayed/denied.</div></div>","PeriodicalId":54245,"journal":{"name":"Practical Radiation Oncology","volume":"15 2","pages":"Pages e100-e108"},"PeriodicalIF":3.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}