Gulstene Stephanie, Mutsaers Adam, O'Neil Melissa, Warner Andrew, Rodrigues George
Division of Radiation Oncology, London Regional Cancer Program, London, CAN.
Schulich School of Medicine & Dentistry, Western University, London, CAN.
Cureus. 2024 Apr 8;16(4):e57839. doi: 10.7759/cureus.57839. eCollection 2024 Apr.
Peer review (PR) of palliative-intent radiation plans is an important but understudied component of quality assurance. This retrospective review aims to improve our understanding of palliative PR by examining the characteristics of reviewed plans and peer feedback along with the associated time burden of two different types of PR processes.
This single-institution, quality assurance project assessed palliative PR between 2018 and 2020. Initially, the PR involved a multi-disciplinary team PR. Subsequently, it transitioned to independent PR by a single physician. Characteristics of reviewed plans and feedback on PR were captured and abstracted. Time requirements of PR were based on self-reported estimates and attendance records.
A total of 1942 cases were reviewed, representing 85.7% (1942/2266) of all palliative-intent plans between 2018 and 2020. A total of 41.1% (n=799) were simple (2D/3D) radiation plans while 56.0% (n=1087) were complex (volumetric modulated arc therapy (VMAT) or tomotherapy) plans. Approximately one-third (30.4%, n=590) of all plans were stereotactic treatments. The rate of any peer feedback was 2.3% (n=45), while the rate of a specific recommended or implemented change was 1.2% (n=24) and 0.9% (n=18), respectively. PR before the start of treatment was associated with more frequent recommended (p=0.005) and implemented changes (p=0.008). Most other factors, including plan complexity and use of stereotactic radiation, were not predictive in this analysis. Comparing the independent versus team PR approach, there was no significant difference in recommended or implemented changes. The mean±standard deviation (SD) staff time required per plan reviewed was 36±6 and 37±6 minutes, including 21±6 and 10±6 minutes of physician time, for team and independent PR, respectively.
This work highlights the high frequency of complex and stereotactic radiation in the palliative setting, along with the importance of timely PR and the potential benefit of reviewing even simple, 2D/3D radiation plans. Additionally, from a process perspective, our work showed that independent PR may require less dedicated physician time.
姑息性放疗计划的同行评审（PR）是质量保证的一个重要但研究不足的组成部分。这项回顾性研究旨在通过检查被评审计划的特征、同行反馈以及两种不同类型PR流程的相关时间负担，来增进我们对姑息性PR的理解。
这个单机构质量保证项目评估了2018年至2020年间的姑息性PR。最初，PR涉及一个多学科团队评审。随后，它转变为由一名医生进行独立评审。记录并提取被评审计划的特征和关于PR的反馈。PR的时间要求基于自我报告的估计和出勤记录。
共评审了1942个病例，占2018年至2020年间所有姑息性放疗计划的85.7%（1942/2266）。其中41.1%（n = 799）为简单（2D/3D）放疗计划，56.0%（n = 1087）为复杂（容积调强弧形放疗（VMAT）或断层放疗）计划。所有计划中约三分之一（30.4%，n = 590）为立体定向治疗。任何同行反馈的比例为2.3%（n = 45），而特定推荐或实施变更的比例分别为1.2%（n = 24）和0.9%（n = 18）。治疗开始前的PR与更频繁的推荐（p = 0.005）和实施变更（p = 0.008）相关。在该分析中，包括计划复杂性和立体定向放疗的使用在内的大多数其他因素并无预测性。比较独立评审与团队评审方法，在推荐或实施变更方面没有显著差异。团队评审和独立评审每评审一个计划所需的平均±标准差（SD）工作人员时间分别为36±6分钟和37±6分钟，其中医生时间分别为21±6分钟和10±6分钟。
这项工作凸显了姑息治疗中复杂和立体定向放疗的高频率，以及及时PR的重要性，以及即使是简单的2D/3D放疗计划评审的潜在益处。此外，从流程角度来看，我们的工作表明独立评审可能需要更少的医生专用时间。
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