Shiue Kevin R, Agrawal Namita, Rhome Ryan M, DesRosiers Colleen M, Hutchins Karen M, Zellars Richard C, Watson Gordon A, Holmes Jordan A
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana.
Adv Radiat Oncol. 2023 Aug 9;9(2):101333. doi: 10.1016/j.adro.2023.101333. eCollection 2024 Feb.
Our multisite academic radiation department reviewed our experience with transitioning from weekly primarily retrospective to daily primarily prospective peer review to improve plan quality and decrease the rate of plan revisions after treatment start.
This study was an institutional review board-approved prospective comparison of radiation treatment plan review outcomes of plans reviewed weekly (majority within 1 week after treatment start) versus plans reviewed daily (majority before treatment start, except brachytherapy, frame-based radiosurgery, and some emergent plans). Deviations were based on peer comments and considered major if plan revisions were recommended before the next fraction and minor if modifications were suggested but not required. Categorical variables were compared using χ distribution tests of independence; means were compared using independent tests.
In all, 798 patients with 1124 plans were reviewed: 611 plans weekly and 513 plans daily. Overall, 76 deviations (6.8%) were noted. Rates of any deviation were increased in the daily era (8.6% vs 5.2%; = .026), with higher rates of major deviations in the daily era (4.1% vs 1.6%; = .012). Median working days between initial simulation and treatment was the same across eras (8 days). Deviations led to a plan revision at a higher rate in the daily era (84.1% vs 31.3%; < .001).
Daily prospective peer review is feasible in a multisite academic setting. Daily peer review with emphasis on prospective plan evaluation increased constructive plan feedback, plan revisions, and plan revisions being implemented before treatment start.
我们的多机构学术放射科回顾了从主要每周进行回顾性同行评审转变为主要每日进行前瞻性同行评审的经验，以提高计划质量并降低治疗开始后计划修订率。
本研究是一项经机构审查委员会批准的前瞻性比较，比较了每周（大多数在治疗开始后1周内）评审的放射治疗计划与每日（大多数在治疗开始前，近距离放射治疗、框架式放射外科和一些紧急计划除外）评审的放射治疗计划的评审结果。偏差基于同行意见，如果建议在下一次分割前进行计划修订，则视为主要偏差；如果建议进行修改但非必需，则视为次要偏差。分类变量使用χ²独立性检验进行比较；均值使用独立样本t检验进行比较。
总共对798例患者的1124个计划进行了评审：每周评审611个计划，每日评审513个计划。总体而言，共发现76个偏差（6.8%）。在每日评审时代，任何偏差的发生率有所增加（8.6%对5.2%；P = 0.026），每日评审时代主要偏差的发生率更高（4.1%对1.6%；P = 0.012）。各时代从初始模拟到治疗的中位工作日相同（8天）。在每日评审时代，偏差导致计划修订的比例更高（84.1%对31.3%；P < 0.001）。
在多机构学术环境中，每日进行前瞻性同行评审是可行的。强调前瞻性计划评估的每日同行评审增加了建设性的计划反馈、计划修订以及在治疗开始前实施的计划修订。
