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Montague E, Roques T, Spencer K, Burnett A, Lourenco J, Thorp N. How Long Does Contouring Really Take? Results of the Royal College of Radiologists Contouring Surveys. Clin Oncol (R Coll Radiol) 2024; 36:335-342. [PMID: 38519383 DOI: 10.1016/j.clon.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
AIMS The success and safety of modern radiotherapy relies on accurate contouring. Understanding the time taken to complete radiotherapy contours is critical to informing workforce planning and, in the context of a workforce shortfall, advocating for investment in technology and multi-professional skills mix. We aimed to quantify the time taken to delineate target volumes for radical radiotherapy. MATERIALS AND METHODS The Royal College of Radiologists circulated two electronic surveys via email to all clinical oncology consultants in the UK. The individual case survey requested anonymous data regarding the next five patients contoured for radical radiotherapy. The second survey collected data on respondents' usual practice in radiotherapy contouring. RESULTS The median time to contour one radiotherapy case was 85 minutes (IQR = 50-131 minutes). Marked variability between and within tumour sites was evident: paediatric cancers took the most time (median = 210 minutes, IQR = 87.5 minutes), followed by head and neck and gynaecological cancers (median = 120 minutes, IQR = 71 and 72.5 minutes respectively). Breast cancer contouring required the least time (median = 43 minutes, IQR = 60 minutes). Radiotherapy technique, inclusion of nodes and 4D CT planning were associated with longer contouring times. A non-medical professional was involved in contouring in 65% of cases, but clinical oncology consultants were involved in target volume delineation in 90% of cases, and OARs in 74%. Peer review took place in 46% of cases with 56% of consultants reporting no time for peer review in their job plan. CONCLUSION Contouring for radical radiotherapy is complex and time-consuming, and despite increasing involvement of non-medical professionals, clinical oncology consultants remain the primary practitioners. Peer review practice is variable and time is often a limiting factor. Many factors influence the time required for contouring, and departments should take these factors and the need for peer-review into account when developing job plans.
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Affiliation(s)
- E Montague
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, UK
| | - T Roques
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Norfolk and Norwich University Hospitals Foundation Trust, Colney Ln, Norwich, UK
| | - K Spencer
- Leeds Cancer Centre, St James's University Hospital, Beckett Street, Leeds, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - A Burnett
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; Weston Park Hospital, Whitham Road, Sheffield, UK
| | - J Lourenco
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK
| | - N Thorp
- Royal College of Radiologists, 63 Lincoln's Inn Fields, London, UK; The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK.
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Li Q, Deng F, Pan X, Bai H, Bai J, Liu X, Chen F, Ge R. Application research on reducing radiation-induced lung injury with a trigger operator based on overlap volume histogram (OVH) in breast cancer postoperative radiotherapy. Sci Rep 2023; 13:22042. [PMID: 38086847 PMCID: PMC10716111 DOI: 10.1038/s41598-023-49282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
This study aims to develop a trigger operator based on the Overlap Volume Histogram (OVH) and examined its effectiveness in enhancing plan quality to minimize radiation-induced lung injury in postoperative radiotherapy for breast cancer. This trigger operator was applied for plan re-optimization to the previous Volumetric Modulated Arc Therapy (VMAT) plans of 16 left breast conserving surgery cases. These cases were categorized into a Contiguous Group (CG) and a Separated Group (SG) based on the relative position between the target and the Left-Lung (L-Lung). We investigated the changes in Vx, mean dose, and Normal Tissue Complication Probability (NTCP) values of organs-at-risk (OARs) before and after using the trigger operator. The Pairwise Sample T test was employed to evaluate the differences in indices between the two groups before and after optimizations. The trigger operator effectively initiated plan re-optimization. The values of V5, V10, V20, V30, and V40 of the L-Lung, as well as the mean dose of the heart, all decreased after re-optimization. The Pairwise Sample T test results showed statistically significant differences in the V20, V30, and V40 of the L-Lung in the CG (P < 0.01), and in the V5, V10, V20, V30, and V40 of the L-Lung in the SG (P < 0.01). Our findings suggest that the proposed trigger operator can improve plan quality, thereby reducing radiation-induced lung injury in postoperative radiotherapy for breast cancer.
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Affiliation(s)
- Qianyan Li
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Feifei Deng
- Department of Oncology, 920Th Hospital of Joint Logistics Support Force, PLA, Kunming, Yunnan, China
| | - Xiang Pan
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Han Bai
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China.
- Department of Physics and Astronomy, Yunnan University, Kunming, Yunnan, China.
| | - Jie Bai
- Department of Radiation Oncology, Daqin Tumor Hospital, Guiyang, Guizhou, China
| | - Xuhong Liu
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Feihu Chen
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, Yunnan, China
| | - Ren Ge
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hongkong, China
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Evaluation of a prospective radiation oncology departmental team review process using standardized simulation directives. Radiother Oncol 2021; 170:102-110. [PMID: 34971659 DOI: 10.1016/j.radonc.2021.12.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/24/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The primary objective of this study is to evaluate the utility and value of an institutional, multi-disciplinary radiation oncology team review process prior to radiotherapy (RT) simulation. METHODS Over a period of 3 months and through an iterative team-based process, a standardized simulation requisition directive (SSRD) was developed, piloted, modified, and subsequently implemented for all patients treated with external beam RT at a single tertiary care institution from January to December 2020. The SSRDs were reviewed at a daily multi-disciplinary radiation oncology team review conference; modifications consequential to the review were prospectively recorded in a quality database. RESULTS 1,500 consecutive SSRDs were prospectively reviewed for this study. 397 modifications on 290 (19.3%) SSRDs were recorded and parsed into 5 main categories and 18 subcategories. The most common modifications resulted from changes in immobilization device (n=88, 22.2%), RT care path (n=56, 14.1%), and arm positioning (n=43, 10.8%). On univariate analysis, modifications were associated with RT intent, scan parameters, tumor site, and consultation type. An increased rate modifications was observed for patients had telemedicine consults (n=101, 22.7%) compared to in-person consultations (n=189, 17.9%) (p=0.032). Using logistic regression analysis, there was also a statistically significant relationship between postoperative RT delivery and modification rates (OR: 2.913, 95% CI: 1.014-8.372) (p=0.0126). Overall, only 14 patients (0.9%) needed re-simulation during the entire study period. CONCLUSIONS Prospective multi-disciplinary radiation oncology team review prior to simulation identifies actionable change in approximately 19% of procedures, and results in an extremely low rate (<1%) of re-simulation. As departmental processes transition to virtual platforms, thorough attention is needed to identify patients at higher risk of simulation modifications.
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Lewis P, Court L, Lievens Y, Aggarwal A. Structure and Processes of Existing Practice in Radiotherapy Peer Review: A Systematic Review of the Literature. Clin Oncol (R Coll Radiol) 2021; 33:248-260. [DOI: 10.1016/j.clon.2020.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 08/04/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
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Ahmad A, Santanam L, Solanki AA, Padilla L, Vlashi E, Guerrieri P, Dominello MM, Burmeister J, Joiner MC. Three discipline collaborative radiation therapy (3DCRT) special debate: Peer review in radiation oncology is more effective today than 20 years ago. J Appl Clin Med Phys 2020; 21:7-13. [PMID: 33232567 PMCID: PMC7700926 DOI: 10.1002/acm2.13103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Anis Ahmad
- Department of Radiation OncologyUniversity of MiamiMiamiFLUSA
| | - Lakshmi Santanam
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | | | - Laura Padilla
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Erina Vlashi
- Department of Radiation OncologyUniversity of CaliforniaLos AngelesCAUSA
| | | | | | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
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100% peer review in radiation oncology: is it feasible? Clin Transl Oncol 2020; 22:2341-2349. [PMID: 32557395 PMCID: PMC7299249 DOI: 10.1007/s12094-020-02394-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
Purpose Peer review has been proposed as a strategy to ensure patient safety and plan quality in radiation oncology. Despite its potential benefits, barriers commonly exist to its optimal implementation in daily clinical routine. Our purpose is to analyze peer-review process at our institution. Methods and materials Based on our group peer-review process, we quantified the rate of plan changes, time and resources needed for this process. Prospectively, data on cases presented at our institutional peer-review conference attended by physicians, resident physicians and physicists were collected. Items such as time to present per case, type of patient (adult or pediatric), treatment intent, dose, aimed technique, disease location and receipt of previous radiation were gathered. Cases were then analyzed to determine the rate of major change, minor change and plan rejection after presentation as well as the median time per session. Results Over a period of 4 weeks, 148 cases were reviewed. Median of attendants was six physicians, three in-training-physicians and one physicist. Median time per session was 38 (4–72) minutes. 59.5% of cases presented in 1–4 min, 32.4% in 5–9 min and 8.1% in ≥ 10 min. 79.1% of cases were accepted without changes, 11.5% with minor changes, 6% with major changes and 3.4% were rejected with indication of new presentation. Most frequent reason of change was contouring corrections (53.8%) followed by dose or fractionation (26.9%). Conclusion Everyday group consensus peer review is an efficient manner to recollect clinical and technical data of cases presented to ensure quality radiation care before initiation of treatment as well as ensuring department quality in a feedback team environment. This model is feasible within the normal operation of every radiation oncology Department.
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Utilization patterns and temporal trends of internal mammary nodal irradiation at a tertiary cancer center. Breast Cancer Res Treat 2020; 182:367-379. [PMID: 32474745 DOI: 10.1007/s10549-020-05708-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The role and uptake of internal mammary nodal irradiation (IMNI) is variable. This study was designed to quantify the rates and determinants of IMNI at a tertiary cancer center. METHODS Consecutively treated breast cancer patients receiving adjuvant locoregional radiation therapy (RT) from January 1, 2012 to December 31, 2017 were sorted by IMNI receipt, disease risk and time period of RT delivery (2012-2015 vs 2016-2017). Differences between risk categories and groups were evaluated using χ2/Fisher's and Mann-Whitney test for categorical and continuous variables, respectively. Univariable and multivariable logistic regression analysis was done to determine factors associated with IMNI receipt. RESULTS A total of 1566 patients were eligible, with 376 in Group 1 (IMNI), and 1190 in Group 2 (no IMNI). The proportion of patients receiving IMNI increased significantly each year (p < 0.0001), and 83% of patients receiving IMNI had pT1-2/pN1 disease. On univariable analysis, younger age, lymphovascular invasion, medial/central quadrant, higher stage, PR negative, mastectomy, axillary dissection, receipt of chemotherapy and nodal positivity had higher odds of IMNI. On multivariable analysis, younger age (p = < 0.001), medial/central quadrant (p = 0.0026), PR negative (p = 0.0011), mastectomy (p = 0.0055), increasing nodal positivity (p < 0.0001) and late cohort (p = 0.001) had increased likelihood of IMNI. The use of deep-inspiration breath hold was significantly higher in those receiving IMNI (45% vs 26%, p < 0.0001), and permitted achievement of acceptable mean heart and lung doses. CONCLUSIONS There was a significant increase in IMNI utilization after 2015. Younger age, medial/central quadrant, PR-negative and node-positive disease predicted for receipt of IMNI. Modern RT techniques permit the safe delivery of IMNI.
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Walburn T, Wang K, Sud S, Zakrzewski A, Roehm R, Sutton S, Tan X, Adams R, Mazur L, Marks LB, Chera BS. A Prospective Analysis of Radiation Oncologist Compliance With Early Peer Review Recommendations. Int J Radiat Oncol Biol Phys 2019; 104:494-500. [DOI: 10.1016/j.ijrobp.2019.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/20/2018] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
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The Impact of Transitioning to Prospective Contouring and Planning Rounds as Peer Review. Adv Radiat Oncol 2019; 4:532-540. [PMID: 31360810 PMCID: PMC6639754 DOI: 10.1016/j.adro.2019.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose Our peer-review program previously consisted of weekly chart rounds performed before the end of the first week of treatment. In order to perform peer review before the start of treatment when possible, we implemented daily prospective contouring and planning rounds (CPR). Methods and materials At the time of computed tomography simulation, patients were categorized by the treating physician into 5 treatment groups based on urgency and complexity (ie, standard, urgent, palliative nonemergent, emergent, and special procedures). A scoring system was developed to record the outcome of case presentations, and the results of the CPR case presentations were compared with the time period 2.5 years before CPR implementation, for which peer review was performed retrospectively. Results CPR was implemented on October 1, 2015, and a total of 4759 patients presented for care through May 31, 2018. The majority were in the standard care path (n = 3154; 66.3%). Among the remainder of the charts, 358 (7.5%), 430 (9.0%), and 179 (3.8%) cases were in the urgent, nonemergent palliative, and emergent care paths, respectively. The remaining patients were in the special procedures group, representing brachytherapy and stereotactic radiosurgery. A total of 125 patients (2.6%) required major changes and were re-presented after the suggested modifications, 102 patients (2.1%) had minor recommendations that did not require a repeat presentation, and 247 cases (5.2%) had minor documentation-related recommendations that did not require editing of the contours. In the 2.5 years before the implementation, records of a total of 1623 patients were reviewed, and only 9 patients (0.6%) had minor recommendation for change. The remainder was noted as complete agreement. Conclusions Contouring and planning rounds were successfully implemented at our clinic. Pretreatment and, most often, preplanning review of contours and directives allows for a more detailed review and changes to be made early on in the treatment planning process. When compared with historical case presentations, the CPR method made our peer review more thorough and improved standardization.
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Khader JK, Al-Mousa AM, Mohamad IA, Abuhijlih RA, Al-Khatib SA, Alnsour AZ, Asha WA, Ramahi SW, Hosni AA, Abuhijla FJ. Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan. Radiat Oncol J 2019; 37:60-65. [PMID: 30947482 PMCID: PMC6453807 DOI: 10.3857/roj.2019.00080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/20/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation or re-planning prior to commencement of RT. Minor modification included treatment plan changes which didn't necessarily require RT re-planning. RESULTS Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.
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Affiliation(s)
- Jamal K. Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Issa A. Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Ramiz A. Abuhijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Anoud Z. Alnsour
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Wafa A. Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Shada W. Ramahi
- Department of Biomedical Physics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali A. Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Fawzi J. Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
- Correspondence: Fawzi J. Abuhijla, MD, MSc, Department of Radiation Oncology, King Hussein Cancer Center, Queen Rania St., P.O. Box 1269, Amman 11941, Jordan. Tel: +962-796500577, Fax: +962-65342567, E-mail:
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Harnett N, Bak K, Lockhart E, Ang M, Zychla L, Gutierrez E, Warde P. The Clinical Specialist Radiation Therapist (CSRT): A case study exploring the effectiveness of a new advanced practice role in Canada. J Med Radiat Sci 2018; 65:86-96. [PMID: 29864246 PMCID: PMC5986013 DOI: 10.1002/jmrs.281] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/29/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Clinical Specialist Radiation Therapist (CSRT), is a new advanced practice (AP) role for radiation therapists (RTTs). Following training, education and evaluation, the CSRT performs specific duties in autonomous ways, making advanced clinical decisions in their area of specialization. This case study examines the CSRT's impact on quantity (i.e., increasing capacity), improving quality and stimulating research and innovation. METHODS Between 2007 and 2016, 23 CSRTs worked in 10 cancer centres in various AP position. A standardised metrics package, focusing on wait-times, patient volumes, patient throughput, time-savings, quality initiatives, satisfaction, research and innovation was developed and used to collect qualitative and quantitative data. Data were self-reported by the CSRTs but electronic databases, pre/post-studies, surveys and interviews were also used. RESULTS Quantity projects (n = 76) related to patient volumes, wait-times, patient throughput and time-savings increased capacity and allowed more patients to enter the system. The presence of a CSRT allowed, on average, 13 additional patients (either new or re-treated) to be seen, at their respective cancer centre, per month. An average of 1.4 yearly quality improvement initiatives were led by each CSRT, which contributed to improvements in quality of care and satisfaction. CSRTs demonstrated a high level of involvement in research, innovation and knowledge translation activities, either as leaders or part of interprofessional teams. CONCLUSION CSRTs positively impact quantity (capacity of the system), quality, research and innovation. Future efforts include permanent and sustainable team integration, practice standards, formal and comprehensive educational preparation, and approaches to consistent, valid assessment of AP in radiation therapy.
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Affiliation(s)
- Nicole Harnett
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
| | - Kate Bak
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | | | - Michelle Ang
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Laura Zychla
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Eric Gutierrez
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
| | - Padraig Warde
- Radiation Medicine ProgramPrincess Margaret Cancer CentreTorontoOntarioCanada
- Radiation Treatment ProgramCancer Care OntarioTorontoOntarioCanada
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Huo M, Gorayski P, Poulsen M, Thompson K, Pinkham M. Evidence-based Peer Review for Radiation Therapy – Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality. Clin Oncol (R Coll Radiol) 2017; 29:680-688. [DOI: 10.1016/j.clon.2017.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 12/16/2022]
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Rouette J, Gutierrez E, O'Donnell J, Reddeman L, Hart M, Foxcroft S, Mitera G, Warde P, Brundage MD, Czarnota G, El-Mallah M, Falkson C, Liu FF, Gulavita S, McMillan W, Pantarotto J, Rachakonda R, Read N, Schneider K, Shehata S, Stevens C, Tsao J, Waldron J, Wells W, Wright J, Warde P, Sharpe M, Lockhart E, Brundage M, Hart M, Caissie A, Hollenhorst H, Wilson L, Parliament M, Milosevic M, Warde P, Halperin R, Foxcroft S, Ebacher A, McGowan T. Directly Improving the Quality of Radiation Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across a Provincial Cancer Program. Int J Radiat Oncol Biol Phys 2017; 98:521-529. [DOI: 10.1016/j.ijrobp.2016.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
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Abstract
Although many error pathways are common to both stereotactic body radiation therapy (SBRT) and conventional radiation therapy, SBRT presents a special set of challenges including short treatment courses and high-doses, an enhanced reliance on imaging, technical challenges associated with commissioning, special resource requirements for staff and training, and workflow differences. Emerging data also suggest that errors occur at a higher rate in SBRT treatments. Furthermore, when errors do occur they often have a greater effect on SBRT treatments. Given these challenges, it is important to understand and employ systematic approaches to ensure the quality and safety of SBRT treatment. Here, we outline the pathways by which error can occur in SBRT, illustrated through a series of case studies, and highlight 9 specific well-established tools to either reduce error or minimize its effect to the patient or both.
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Affiliation(s)
- Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, WA.
| | - Sonja Dieterich
- Department of Radiation Oncology, University of California, Davis, CA
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Brunskill K, Nguyen TK, Boldt RG, Louie AV, Warner A, Marks LB, Palma DA. Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature. Int J Radiat Oncol Biol Phys 2017; 97:27-34. [DOI: 10.1016/j.ijrobp.2016.09.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Mackenzie J, Graham G, Olivotto I. Peer Review of Radiotherapy Planning: Quantifying Outcomes and a Proposal for Prospective Data Collection. Clin Oncol (R Coll Radiol) 2016; 28:e192-e198. [DOI: 10.1016/j.clon.2016.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/20/2016] [Accepted: 07/20/2016] [Indexed: 11/28/2022]
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Trends in use and outcome of postoperative radiotherapy following mastectomy: A population-based study. Radiother Oncol 2016; 122:2-10. [PMID: 27641786 DOI: 10.1016/j.radonc.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of the present population-based study was to evaluate the role and effectiveness of postmastectomy radiation therapy (PMRT) in clinical practice. METHODS The study included 16,675 patients diagnosed with invasive breast cancer from 1988 to 2012 and resident within the catchment area of the Munich Cancer Registry. Use of PMRT, local recurrence-free survival (LRFS), cumulative incidence of time to local recurrence, relative survival and conditional overall survival (cOS), were analysed for different time periods (1988-1997 and 1998-2012). RESULTS Variables favouring the use of PMRT on multivariate logistic regression analysis included young age, large tumour size, positive resection margin and positive nodal status. Over time, a significant increase of PMRT was registered for patients with ⩾4 positive lymph nodes. Moreover, the present findings track a less frequent use of PMRT in elderly patients. After adjusting for age, tumour characteristics and therapies, the Cox regression analysis for LRFS identified PMRT as an independent predictor for improved local control (HR: 2.145; 95% CI: 1.787-2.574, p<0.0001). Patients with 1-3 involved lymph nodes had a 10-year cumulative incidence of local recurrence of 13.7% following mastectomy, compared to 6.5% following PMRT (p=0.0001). Comparable findings were obtained for patients presenting with ⩾4 positive lymph nodes. All effects were smaller or extinct in elderly patients aged ⩾70years. On multivariate analysis for cOS, no significant advantage for PMRT could be detected (HR: 1.084; 95% CI: 0.986-1.191, p=0.095). CONCLUSION The present study was useful in providing an overview on trends in the adoption of PMRT over a 25-year period. An increase in the use of PMRT from 1988 to 2012 was observed, especially in high-risk patients with ⩾4 positive lymph nodes. Patients selected for PMRT had an improved local control and an equivalent relative survival compared to patients who had no indication for PMRT.
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Caissie A, Rouette J, Jugpal P, Davis CA, Hollenhorst H, O'Donnell J, Mitera G, Brundage MD. A pan-Canadian survey of peer review practices in radiation oncology. Pract Radiat Oncol 2016; 6:342-351. [PMID: 27025163 DOI: 10.1016/j.prro.2016.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/28/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Peer review (PR) of treatment plans has been recognized internationally as a key component of quality care in radiation oncology programs (ROPs). We conducted a survey of Canadian ROPs to describe current PR practices and identify barriers/facilitators to PR optimization. METHODS AND MATERIALS A 42-item e-survey was sent to all Canadian ROPs (n = 44). Survey development was guided by expert consensus, literature review, and existing guidelines. One multidisciplinary response per ROP was requested. RESULTS Response rate was 100.0% (44/44). All ROPs (100.0%) reported conducting some PR and rated its importance as 7/10 or higher (10 = extremely important). One-half of ROPs (52.3%) peer-reviewed >80% of curative treatment plans. ROPs reported performing PR "always/almost always" pretreatment (38.6%) or before 25% of radiation therapy delivery (52.3%). The majority of ROPs reported recommending major plan changes in <5% of plans (88.6%) and documenting findings in the medical record (58.1%). Barriers to PR were radiation oncologist availability (34.1%) and time constraints (27.3%). Facilitators included development of PR standards (97.7%) and education/support (90.9%). CONCLUSIONS The ROPs perceive PR as highly important, but substantial variation in the extent, timing, and documentation of PR exists. The understanding of current PR activities, barriers, and facilitators will inform the development of initiatives to optimize PR in radiation oncology.
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Affiliation(s)
- Amanda Caissie
- Department of Radiation Oncology, Dalhousie University, Saint John, NB, Canada
| | - Julie Rouette
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - Paul Jugpal
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Carol-Anne Davis
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada; Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Helmut Hollenhorst
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Jennifer O'Donnell
- Radiation Therapy Services, Nova Scotia Cancer Center, Halifax, NS, Canada
| | - Gunita Mitera
- Canadian Partnership Against Cancer, Toronto, Canada; Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michael D Brundage
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada; Department of Oncology, Queen's University, Kingston, ON, Canada.
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Cox BW, Kapur A, Sharma A, Lee L, Bloom B, Sharma R, Goode G, Potters L. Prospective contouring rounds: A novel, high-impact tool for optimizing quality assurance. Pract Radiat Oncol 2015. [DOI: 10.1016/j.prro.2015.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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