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Dragojević I, Hoopes D, Mansy G, Rahn D. Radiation Oncology Peer Review in a Community Setting: The Value of Prospective Review. Med Dosim 2024; 49:239-243. [PMID: 38368183 DOI: 10.1016/j.meddos.2024.01.006] [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: 06/02/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Abstract
Peer review is an important component of any radiation oncology continuous quality improvement program. While limited guidelines exist, there is no consensus about how peer review should be performed, and large variations exist among different institutions. The purpose of this report is to describe our experience with peer review at a busy Radiation Oncology clinic and to evaluate the difference between prospective and retrospective peer review. We also performed a failure modes and effects analysis (FMEA) of the peer review process. Starting in 2015, every peer review session was tracked, including recommended changes to treatment plans. We reviewed the frequency, types and severity of these changes. A team of physicians and physicists conducted an FMEA of the peer review process. Between April 2015 and June 2020, a total of 3,691 patients were peer-reviewed. Out of those, 1,903 were prospective reviews (51.6%). Plans reviewed before treatment were almost 4.5 times more likely to be changed by peer review than those reviewed after the start of treatment (0.9% vs 0.2%). Plan changes after the start of treatment had a higher severity than changes prior to the start of treatment. FMEA identified several critical components of peer review. While there is no national standard for peer review, it is evident that prospective peer review is preferable. There may be a subconscious reluctance to change plans already underway, which could be a barrier to improving plans with the peer review process. Rather than reviewing in a group setting, it would be ideal to individually assign review tasks that are embedded in the clinical flow, assuring prospective review for all patients prior to final physician approval. Individual review rather than group review may be more candid, due to interpersonal concerns about publicly disagreeing with colleagues.
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Affiliation(s)
- Irena Dragojević
- Department of Radiation Medicine & Applied Sciences UC San Diego Health 3855 Health Sciences Drive MC 0843 La Jolla, CA 92093-1503.
| | - David Hoopes
- Department of Radiation Medicine & Applied Sciences UC San Diego Health 3855 Health Sciences Drive MC 0843 La Jolla, CA 92093-1503
| | - Gina Mansy
- Department of Radiation Medicine & Applied Sciences UC San Diego Health 3855 Health Sciences Drive MC 0843 La Jolla, CA 92093-1503
| | - Douglas Rahn
- Department of Radiation Medicine & Applied Sciences UC San Diego Health 3855 Health Sciences Drive MC 0843 La Jolla, CA 92093-1503
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Rubagumya F, Mushonga M, Abdihamid O, Nyagabona S, Hopman W, Nwamaka L, Omar AA, Ndlovu N, Booth C, Aggarwal A, Brundage M, Vanderpuye V, de Moraes FY. Status of Peer Review in Radiation Oncology: A Survey of Cancer Centers in Sub-Saharan Africa. Int J Radiat Oncol Biol Phys 2023; 116:984-991. [PMID: 37453798 DOI: 10.1016/j.ijrobp.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda; Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | - Melinda Mushonga
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Omar Abdihamid
- Garissa Cancer Center-Garissa County Referral Hospital, Garissa, Kenya
| | - Sarah Nyagabona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wilma Hopman
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre Research Institute, Kingston, Ontario, Canada
| | | | - Abeid Athman Omar
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and; Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
| | | | - Fabio Ynoe de Moraes
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada; Departments of Oncology and
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Zhang H, Cha EE, Lynch K, Gennarelli R, Brower J, Sherer MV, Golden DW, Chimonas S, Korenstein D, Gillespie EF. Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study. J Med Imaging Radiat Oncol 2022; 66:993-1002. [PMID: 35650174 PMCID: PMC9532345 DOI: 10.1111/1754-9485.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We aimed to assess contouring-related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual- and organization-level factors. METHODS We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis. RESULTS Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02). CONCLUSION Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.
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Affiliation(s)
- Helen Zhang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elaine E. Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathleen Lynch
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renee Gennarelli
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey Brower
- Radiation Oncology Associates–New England, Manchester, NH
| | - Michael V. Sherer
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Daniel W. Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - Susan Chimonas
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah Korenstein
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY
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Hughes RT, Tye KE, Ververs JD, O’Connell NS, Helis CA, Steber CR, Johnson AG, Chan MD, Farris MK. Virtual Radiation Oncology Peer Review is Associated With Decreased Engagement and Limited Case Discussion: Analysis of a Prospective Database Before and During the COVID-19 Pandemic. Int J Radiat Oncol Biol Phys 2022; 113:727-731. [PMID: 35489631 PMCID: PMC9798912 DOI: 10.1016/j.ijrobp.2022.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Karen E. Tye
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - James D. Ververs
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Nathaniel S. O’Connell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Corbin A. Helis
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina,Department of Radiation Oncology, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Cole R. Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Adam G. Johnson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael D. Chan
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Michael K. Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina
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Chang D, Moore A, van Dyk S, Khaw P. Why quality assurance is necessary in gynecologic radiation oncology. Int J Gynecol Cancer 2022; 32:402-406. [DOI: 10.1136/ijgc-2021-002534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/16/2021] [Indexed: 11/03/2022] Open
Abstract
Quality assurance (QA) in radiation oncology involves all checks and processes that ensure that radiotherapy is delivered in an optimal and intended manner. QA is essential for the accurate delivery of brachytherapy and external beam radiotherapy in patients diagnosed with gynecologic malignancies. Inadequate QA can adversely impact clinical outcomes and reduce the reliability of clinical trials. This review highlights the importance of QA in gynecologic radiation oncology and explores the pertinent issues related to its implementation.
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Chin S, Or M, Ong WL, Millar J, Chilkuri M, Vinod S. Radiation oncology peer review in Australia and New Zealand. J Med Imaging Radiat Oncol 2022; 66:258-266. [PMID: 35243786 DOI: 10.1111/1754-9485.13360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Peer review is a part of high quality care within radiation oncology, designed to achieve the best outcomes for patients. We discuss the importance of and evidence for peer review in clinical practice. The Royal Australia and New Zealand College of Radiologists (RANZCR) has evolved a Peer Review Assessment Tool (PRAT) since 1999. We report the results of a RANZCR faculty survey conducted in radiation oncology facilities across Australia and New Zealand to guide the 2019 PRAT revision process, and discuss the development and implementation of the 2019 PRAT. Peer-review processes are now mandated as a component of Australian and International Quality Standards. Several practical recommendations might address challenges for effective implementation of peer review process in routine clinical practice. This includes prioritising tumour sites and treatment techniques for peer review within the time and resources constraints of each institution, improving resource allocation, ensuring optimal timing and duration for peer review meetings, and adopting multi-centre virtual peer review meeting where necessary.
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Affiliation(s)
- Stephen Chin
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia
| | - Michelle Or
- Crown Princess Mary Cancer Centre Westmead, Westmead Hospital, Sydney, New South Wales, Australia
| | - Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne, Victoria, Australia
| | - Madhavi Chilkuri
- Townsville University Hospital, Townsville, Queensland, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, & Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
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West K, Hardcastle-Fowler T, Coburn N, Beldham-Collins R, Harris J, Ahern V. The impact of radiation therapist-led structured peer review meetings on compliance to Radiation Oncology Practice Standards. J Med Imaging Radiat Oncol 2021; 66:129-137. [PMID: 34747139 DOI: 10.1111/1754-9485.13346] [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: 06/29/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Regular tumour-specific peer review meetings (TPRMs) were established by our group during 2016. A dedicated Quality Assurance Radiation Therapist (QART) was employed in 2018 to co-ordinate the meetings and for each patient, complete the Peer Review Audit Tool (PRAT) of the Royal Australian and New Zealand College of Radiologists (RANZCR). The aim of the current quality assurance study was to investigate the impact of the TPRMs and appointment of the QART on compliance to relevant RANZCR Radiation Oncology Practice Standards (ROPS). METHODS Tumour-specific peer review meetings for eight tumour sites were assessed across our group's three hospitals from January 2017 to December 2019. Data from meetings were collected using the PRAT or from paper-based minutes and assessed against four ROPS (ROPS 3, 4, 8 and 9). Compliance with each of the four standards was measured by presence of the required documentation and presentation at TPRM, as recorded by the PRAT. RESULTS There was an increase in the overall number of peer review cases audited from 173 in the 2017 calendar year to 469 in 2018 and 619 in 2019, representing 7%, 18% and 22% of all treatment courses started during these years, respectively. Staging was the most incompletely documented item across all years for audited patients. The request for radiation treatment plan modifications increased year-on-year: modifications were requested for 5% of plans in 2017 (8/172), 18% in 2018 (81/452) and 19% (119/619) in 2019. CONCLUSION This study has shown that an increase in the number of cases for peer-review audit corresponded to the QART-facilitated TPRMs. Application of the PRAT has identified radiation treatment plan modifications that would otherwise go undetected and without opportunity to improve the quality of patients' treatment or avoid harm.
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Affiliation(s)
- Katrina West
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown, New South Wales, Australia
| | - Tegan Hardcastle-Fowler
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown, New South Wales, Australia
| | - Natalie Coburn
- Nepean Cancer and Wellness Centre, Penrith, New South Wales, Australia
| | - Rachael Beldham-Collins
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown, New South Wales, Australia.,Nepean Cancer and Wellness Centre, Penrith, New South Wales, Australia
| | - Jill Harris
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown, New South Wales, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Centre, Westmead, New South Wales, Australia.,Blacktown Cancer and Haematology Centre, Blacktown, New South Wales, Australia.,Western Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Breast Cancer Institute, Westmead, New South Wales, Australia
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8
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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Glicksman RM, Bhaskaran A, Nanthakumar K, Lindsay P, Coolens C, Conroy L, Letourneau D, Lok BH, Giuliani M, Hope A. Implementation of Cardiac Stereotactic Radiotherapy: From Literature to the Linac. Cureus 2021; 13:e13606. [PMID: 33816005 PMCID: PMC8011471 DOI: 10.7759/cureus.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Stereotactic radiotherapy (SBRT) has been applied to treat cardiac arrhythmias, but our institution had not yet implemented this technique. Here, we explain how we used implementation science and knowledge translation to provide cardiac SBRT to a critically ill patient with malignancy-associated refractory ventricular tachycardia. We reviewed the critical factors that enabled the implementation of this urgent treatment, such as the context of the implementation, the characteristics of the intervention, and the stakeholders. These principles can be used by other radiation programs to implement novel treatments in urgent settings, where the gold standard process of planning and developing policies and protocols is not possible.
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Affiliation(s)
- Rachel M Glicksman
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Abhishek Bhaskaran
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Kumaraswamy Nanthakumar
- The Hull Family Cardiac Fibrillation Management Laboratory, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, CAN
| | - Patricia Lindsay
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Catherine Coolens
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Leigh Conroy
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Daniel Letourneau
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Benjamin H Lok
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Meredith Giuliani
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
| | - Andrew Hope
- Radiation Medicine Program/Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, CAN
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10
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Kotecha R, LeGrand LA, Valladares MA, Castillo AM, Rubens M, Quintana G, Chisem M, Appel H, Chuong MD, Hall MD, Contreras JA, Fagundes M, Gutierrez A, Mehta MP. A Comprehensive Analysis of a Prospective Multidisciplinary Peer Review Process Before Radiation Therapy Simulation. Pract Radiat Oncol 2020; 11:e366-e375. [PMID: 33197645 DOI: 10.1016/j.prro.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Although peer review in radiation oncology (RO) has been recommended to improve quality of care, an analysis of modifications resulting from an RO multidisciplinary presimulation standardized review process has yet to be empirically demonstrated. METHODS AND MATERIALS A standardized simulation directive was used for patients undergoing simulation for external beam radiation therapy at a single tertiary care institution. The simulation directives were presented, and all aspects were reviewed by representatives from key RO disciplines. Modifications to the original directives were prospectively captured in a quality improvement registry. Association between key variables and the incidence of modifications were performed using Fisher exact test and t test. RESULTS A registry of 500 consecutive simulations for patients undergoing radiation therapy was reviewed. A median of 105 simulations occurred per month. All simulation directives were entered by a physician a median of 3 days before simulation (range, 1-76 days). The treatment intent was curative for 269 patients (53.8%), palliative for 203 patients (40.6%), and benign for 3 patients (0.6%). Twenty-five (5%) patients did not have a treatment intent selected. Based on RO multidisciplinary review, 105 directives (21%) were modified from the original intent, with 29 (5.8%) requiring more than 1 modification. A total of 149 modifications were made and categorized as changes to patient positioning and immobilization (n = 100, 20%), treatment site and care path (n = 34, 6.8%), simulation coordination activities (n = 6, 1.2%), and treatment technique and planning instructions (n = 9, 1.8%). A higher proportion of modifications occurred at the time of multidisciplinary review in patients receiving more complex treatments (intensity modulated radiation therapy/stereotactic radiosurgery/stereotactic body radiation therapy [IMRT/SRS/SBRT] vs 3-dimensional radiation therapy [3DCRT] radiation therapy, 25% vs 16%, P < .025). CONCLUSIONS Given the complexity of radiation therapy simulation, standardization of directives with prospective RO multidisciplinary presimulation peer review is critical to optimizing department processes and reducing errors. Approximately 1 in 5 patients benefits from this peer review process, especially patients treated with IMRT/SRS/SBRT.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
| | - Lorrie A LeGrand
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Maria A Valladares
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Andrea M Castillo
- Department of Clinical Informatics, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Gabriella Quintana
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Monique Chisem
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Haley Appel
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Jessika A Contreras
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Marcio Fagundes
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Alonso Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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11
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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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Owens R, Mukherjee S, Padmanaban S, Hawes E, Jacobs C, Weaver A, Betts M, Muirhead R. Intensity-Modulated Radiotherapy With a Simultaneous Integrated Boost in Rectal Cancer. Clin Oncol (R Coll Radiol) 2020; 32:35-42. [DOI: 10.1016/j.clon.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/31/2019] [Accepted: 07/06/2019] [Indexed: 02/06/2023]
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Mercieca S, Belderbos J, Gilson D, Dickson J, Pan S, van Herk M. Implementing the Royal College of Radiologists' Radiotherapy Target Volume Definition and Peer Review Guidelines: More Still To Do? Clin Oncol (R Coll Radiol) 2019; 31:706-710. [DOI: 10.1016/j.clon.2019.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
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Qureshi BM, Mansha MA, Karim MU, Hafiz A, Ali N, Mirkhan B, Shaukat F, Tariq M, Abbasi AN. Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan. J Glob Oncol 2019; 5:1-7. [PMID: 31393752 PMCID: PMC6733206 DOI: 10.1200/jgo.19.00039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week. MATERIALS AND METHODS Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively. RESULTS Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%). CONCLUSION Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans.
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Affiliation(s)
| | | | | | - Asim Hafiz
- The Aga Khan University, Karachi, Pakistan
| | - Nasir Ali
- The Aga Khan University, Karachi, Pakistan
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Vijayakumar S, Duggar WN, Packianathan S, Morris B, Yang CC. Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review. Front Oncol 2019; 9:302. [PMID: 31069170 PMCID: PMC6491674 DOI: 10.3389/fonc.2019.00302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/01/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose: The Joint Commission has encouraged the healthcare industry to become “High Reliability Organizations” by “Chasing Zero Harm” in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to “chase zero” in radiation oncology, peer review has to be implemented prior to treatment initiation. A multidisciplinary group consensus peer review (GCPR) model is used pre-treatment at our institution and has been successful in our efforts to “chase zero harm” in patient care. Methods: With the GCPR model, policy-defined complex cases go through a treatment planning conference, which includes physicians, residents, physicists, and dosimetrists. Three major plan aspects are reviewed: target volumes, target and normal tissue dose coverage, and dose distributions. During the review, any team member can ask questions and afterwards a group consensus is taken regarding plan approval. Results: The GCPR model has been implemented through a commitment to peer review and creative conference scheduling. Automated analysis software is used to depict color-coded results for department approved target coverage and dose constraints. About 8% of plans required re-planning while about 23% required minor changes. The mean time for review of each plan was 8 min. Conclusions: Catching errors prior to treatment is the only way to “chase zero” in radiation oncology. Various types of errors may exist in treatment plans and our GCPR model succeeds in preventing many errors of all shapes and sizes in target definition, dose prescriptions, and treatment plans from ever reaching the patients.
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Affiliation(s)
- Srinivasan Vijayakumar
- Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States
| | - William Neil Duggar
- Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States
| | - Satya Packianathan
- Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States
| | - Bart Morris
- Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States
| | - Chunli Claus Yang
- Radiation Oncology Department, University of MS Medical Center, Jackson, MS, United States
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Cox S, Cleves A, Clementel E, Miles E, Staffurth J, Gwynne S. Impact of deviations in target volume delineation - Time for a new RTQA approach? Radiother Oncol 2019; 137:1-8. [PMID: 31039468 DOI: 10.1016/j.radonc.2019.04.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 10/26/2022]
Abstract
The international radiotherapy community has recognised that non-adherence to RT protocols can influence trial endpoints. However this conclusion is based on studies predominantly assessing the impact of deviations in dosimetric or treatment delivery protocol parameters rather than target volume delineation (TVD). This review evaluates the assessment of TVD within Radiation Therapy Quality Assurance (RTQA) programmes in clinical trials and the clinical impact of TVD protocol deviations. The implications for RTQA programmes are discussed. MEDLINE, PreMEDLINE, Embase, Cochrane Library, Web of Science, OpenGrey, WHO International Clinical Trials Registry Platform portal and ClinicalTrials.gov were searched. Full-length articles and conference abstracts were included to avoid publication bias. 5864 abstracts were screened for relevance; 94 full-length articles were reviewed and 5 relevant trials identified. Various classification systems were used to assess protocol deviations; 'unacceptable' or 'major' deviations in TVD occurred in 2.9-13.4% of assessed RT plans (when reported). It was often not possible to establish deviation rates specifically related to TVD as these were frequently combined with other types of protocol deviations. Details on the nature of unacceptable deviations was also not routinely reported and difficulties in establishing a 'consensus' for appropriate TVD for on-trial patients highlighted. Results suggest that deviations in TVD were associated with poorer outcomes for overall survival, local control and treatment-related toxicity; however the data were heterogeneous. RTQA of TVD was retrospective and feedback on the quality of TVD to recruiting centres was not standard. In summary, few trials have published outcomes on the impact of assessing the quality of TVD in trials. We propose that a new approach is now required. Unacceptable TVD deviations must be clearly defined at the time of protocol development to minimise interobserver variation, thereby promoting consistency in RTQA feedback. Prospective TVD reviews should be implemented for trials involving novel or complex RT techniques to identify deviations that require modification prior to treatment delivery. Furthermore, the consistent reporting of RTQA programme outcomes, both within and across trial groups, is of paramount importance to accelerate the evidence-base for the best RTQA approach when assessing TVD and to enable the impact on clinical outcomes within RT trials to be assessed.
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Affiliation(s)
- Samantha Cox
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK.
| | - Anne Cleves
- Velindre NHS Trust Library, Velindre Cancer Centre, Cardiff, UK
| | | | | | - John Staffurth
- School of Medicine, Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Sarah Gwynne
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK; Swansea University Medical School, Swansea, UK
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Thompson D, Cox K, Loudon J, Yeung I, Wells W. Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent. J Oncol Pract 2018; 14:e794-e800. [PMID: 30537455 DOI: 10.1200/jop.18.00379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. METHODS AND MATERIALS Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. RESULTS Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. CONCLUSION Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.
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Affiliation(s)
- Dina Thompson
- Southlake Regional Health Centre, Newmarket; and University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Cox
- Southlake Regional Health Centre, Newmarket; and University of Toronto, Toronto, Ontario, Canada
| | - James Loudon
- Southlake Regional Health Centre, Newmarket; and University of Toronto, Toronto, Ontario, Canada
| | - Ivan Yeung
- Southlake Regional Health Centre, Newmarket; and University of Toronto, Toronto, Ontario, Canada
| | - Woodrow Wells
- Southlake Regional Health Centre, Newmarket; and University of Toronto, Toronto, Ontario, Canada
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Riegel AC, Vaccarelli M, Cox BW, Chou H, Cao Y, Potters L. Impact of Multi-Institutional Prospective Peer Review on Target and Organ-at-Risk Delineation in Radiation Therapy. Pract Radiat Oncol 2018; 9:e228-e235. [PMID: 30415075 DOI: 10.1016/j.prro.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/02/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Peer review is an essential component of quality assurance programs in radiation oncology. The purpose of this work was to assess whether peer reviewers recommend expansion or reduction of planning target volumes (PTVs) and organs at risk (OARs) in prospective multidisciplinary daily contour rounds. METHODS AND MATERIALS The peer group evaluated the appropriateness of PTVs and OARs for each case according to evidence-based departmental directives. We reviewed 7645 cases that presented between September 2013 and March 2017. We isolated recommendations for PTV/OAR modification and classified each as expansion, reduction, both, or indeterminate. Recommendations were analyzed by technique, site, and physician experience. RESULTS Eight junior and 7 senior radiation oncologists were included. PTV or OAR modifications were recommended for 750 of 7645 prescriptions (9.7%). The peer group recommended PTV modifications for 534 prescriptions (7.0%): There were 309 expansions (57.9%), 115 reductions (21.5%), 15 both (2.8%), and 95 indeterminate (17.8%). Reasons for PTV expansions included increased nodal coverage and inadequate margins as a result of motion. The peer group recommended OAR modifications for 216 prescriptions (2.8%): There were 102 expansions (47.2%), 23 reductions (10.6%), 2 both (0.9%), and 89 indeterminate (41.2%). Reasons for OAR expansions included missing critical structures and inadequate extent as per departmental standardization. Head and neck represented the largest percentage of PTV recommendations (28.8%). Intensity modulated radiation therapy plans received the most PTV and OAR recommendations (66.8% and 74.5%, respectively). The recommendation rate for senior and junior faculty was 43% and 28%, respectively. CONCLUSIONS Peer review resulted in recommendations for PTV or OAR change for approximately 10% of cases. Expansions of PTV were recommended >2.5 times more often than reductions and >3 times more often than OAR expansions. This general trend was identified for treatment technique, site, and physician experience. Prospective peer review could yield systematically larger volumes, which could affect multicenter clinical trials.
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Affiliation(s)
- Adam C Riegel
- Department of Radiation Medicine, Northwell Health, Lake Success, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| | - Marissa Vaccarelli
- Department of Physics and Engineering Physics, Fordham University, Bronx, New York
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health, Lake Success, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Henry Chou
- Department of Radiation Medicine, Northwell Health, Lake Success, New York
| | - Yijian Cao
- Department of Radiation Medicine, Northwell Health, Lake Success, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health, Lake Success, New York; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Group consensus peer review in radiation oncology: commitment to quality. Radiat Oncol 2018; 13:55. [PMID: 29587867 PMCID: PMC5870168 DOI: 10.1186/s13014-018-1006-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/21/2018] [Indexed: 01/20/2023] Open
Abstract
Background Peer review, especially prospective peer review, has been supported by professional organizations as an important element in optimal Radiation Oncology practice based on its demonstration of efficacy at detecting and preventing errors prior to patient treatment. Implementation of peer review is not without barriers, but solutions do exist to mitigate or eliminate some of those barriers. Methods Peer review practice at our institution involves three key elements: new patient conference, treatment planning conference, and chart rounds. The treatment planning conference is an adaptation of the group consensus peer review model from radiology which utilizes a group of peers reviewing each treatment plan prior to implementation. The peer group in radiation oncology includes Radiation Oncologists, Physician Residents, Medical Physicists, Dosimetrists, and Therapists. Thus, technical and clinical aspects of each plan are evaluated simultaneously. Results Though peer review is held in high regard in Radiation Oncology, many barriers commonly exist preventing optimal implementation such as time intensiveness, repetition, and distraction from clinic time with patients. Through the use of automated review tools and commitment by individuals and administration in regards to staffing, scheduling, and responsibilities, these barriers have been mitigated to implement this Group Consensus Peer Review model into a Radiation Oncology Clinic. Conclusion A Group Consensus Peer Review model has been implemented with strategies to address common barriers to effective and efficient peer review.
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Roach D, Jameson MG, Dowling JA, Ebert MA, Greer PB, Kennedy AM, Watt S, Holloway LC. Correlations between contouring similarity metrics and simulated treatment outcome for prostate radiotherapy. ACTA ACUST UNITED AC 2018; 63:035001. [DOI: 10.1088/1361-6560/aaa50c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Bhandari RP, Duggar WN, Yang C, Kanakamedala MR, Packianathan S, Giri SP, Mangana SH, Allbright RM, Vijayakumar S. A Sustainable Model for Peer Review and Utility of At-a-Glance Analysis of Dose Volume Histogram in Radiation Oncology. J Am Coll Radiol 2017; 15:310-312. [PMID: 29217308 DOI: 10.1016/j.jacr.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Rahul P Bhandari
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi.
| | - William N Duggar
- Division of Radiation Oncology Physics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Chunli Yang
- Division of Radiation Oncology Physics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Madhava R Kanakamedala
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Satya Packianathan
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Shankar P Giri
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sophy H Mangana
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Robert M Allbright
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
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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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Liszewski B, Angers C, Kildea J. Mitigating the Barriers to a Culture of Quality and Safety in Radiation Oncology. Clin Oncol (R Coll Radiol) 2017; 29:676-679. [PMID: 28844311 DOI: 10.1016/j.clon.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- B Liszewski
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
| | - C Angers
- The Ottawa Hospital Cancer Centre, 501 Smyth Rd, Box 927, Ottawa, Ontario K1H 8L6, Canada
| | - J Kildea
- Cancer Research Program of the McGill University Health Centre, Cedars Cancer Centre, DS1.7141, 1001 boul Décarie, Montréal, Québec H4A 3J1, Canada
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Brundage MD, Hart M, O’Donnell J, Reddeman L, Gutierrez E, Foxcroft S, Warde P. “I sleep better at night:” How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs. Pract Radiat Oncol 2017; 7:281-288. [DOI: 10.1016/j.prro.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/17/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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Adleman J, Gillan C, Caissie A, Davis CA, Liszewski B, McNiven A, Giuliani M. Development of a Quality and Safety Competency Curriculum for Radiation Oncology Residency: An International Delphi Study. Int J Radiat Oncol Biol Phys 2017; 98:428-437. [DOI: 10.1016/j.ijrobp.2016.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 11/13/2016] [Accepted: 11/19/2016] [Indexed: 12/20/2022]
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Review of the clinical benefits and implementation of peer review of treatment plans in undergraduate medical dosimetry and radiation therapy training. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396916000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposePeer review of treatment plans has been used to improve planning consistency, decrease the need for replanning and improve quality of care through the safe delivery of high-quality radiotherapy plans. This narrative review summarises the clinical benefits and addresses the implementation of peer review of treatment plans in undergraduate medical dosimetry and radiation therapy training.DiscussionThere are encouraging results of peer review for advanced treatment planning techniques such as Stereotactic Body Radiation Therapy techniques in clinical practice. Peer review can be used as a tool to improve students’ knowledge of organ-at-risk contouring, treatment plan critique and quality assurance. These desirable treatment planning skills can be easily transferred to clinical settings. Moreover, there are several potential pedagogical benefits such as improvement in student engagement, better communication skills and provision of synchronous and asynchronous feedback that can positively impact student success and future employment. However, there are several challenges in facilitating its implementation in university settings.ConclusionEmbedding skills in peer review of treatment plans at undergraduate teaching level can be a powerful tool to impart clinical treatment planning knowledge. This narrative review provides a basis on which to develop an exploratory study of structured peer review activities in a training environment.
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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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Vinod SK, Min M, Jameson MG, Holloway LC. A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology. J Med Imaging Radiat Oncol 2016; 60:393-406. [DOI: 10.1111/1754-9485.12462] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/16/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Shalini K Vinod
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
| | - Myo Min
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
| | - Michael G Jameson
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
- Centre for Medical Radiation Physics; University of Wollongong; Wollongong New South Wales Australia
| | - Lois C Holloway
- Cancer Therapy Centre; Liverpool Hospital; Liverpool New South Wales Australia
- South Western Sydney Clinical School; University of NSW; Sydney New South Wales Australia
- Western Sydney University; Sydney New South Wales Australia
- Ingham Institute of Applied Medical Research; Liverpool Hospital; Liverpool New South Wales Australia
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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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Reddeman L, Foxcroft S, Gutierrez E, Hart M, Lockhart E, Mendelsohn M, Ang M, Sharpe M, Warde P, Brundage M, Reddeman L, Foxcroft S, Gutierrez E, Hart M, Lockhart E, Mendelsohn M, Ang M, Sharpe M, Warde P, Brundage M. ReCAP: Improving the Quality of Radiation Treatment for Patients in Ontario: Increasing Peer Review Activities on a Jurisdictional Level Using a Change Management Approach. J Oncol Pract 2016; 12:81-2, e61-70. [DOI: 10.1200/jop.2015.006882] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
QUESTION ASKED: What is the impact of the Cancer Care Ontario (CCO) strategy (designed with guidance from a change management framework) to accelerate the use of peer-review processes in radiation oncology (ie, review of a radiation oncologist’s proposed treatment plan by a second radiation oncologist with or without additional multidisciplinary input) across all of its 14 cancer treatment centers? SUMMARY ANSWER: By following a number of key change management principles for organizational transformation, the proportion of radical-intent radiation therapy courses peer reviewed province-wide increased from 43.5% (April 2013) to 68.0% (March 2015), with some centers reaching over 95%. METHODS: The initiative design was guided by the Kotter eight-step process for organizational transformation, including the creation of a multidisciplinary leadership team, site visits to individual centers, the development of education and implementation processes (done in collaboration with each center), and the creation of new performance metrics for central reporting. Monitoring of these metrics enabled the leadership team to track the percentage of radiation therapy courses peer reviewed and the timing of peer review (before 25% treatment visits complete, after 25% treatment visits complete). Performance targets for the quality measures were arrived at by consensus that included engagement of all center radiation treatment program leaders. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Peer review has been shown to increase quality of care. However, it requires that resources be invested, including the time and effort of radiation oncologists, and the programmatic work required to organize, execute, and document peer-review activities. There is currently no way of confirming the quality of peer-review activities. REAL-LIFE IMPLICATIONS: A change management framework can be useful for planning and achieving substantial increases in peer-review activities on a jurisdictional basis. Ongoing work will capitalize on facilitators of peer review and on addressing barriers to its application that were identified as part of the initiative. Guidance for peer-review activities specific to common clinical cases is required and is under development. The principles of peer review could be extended to other oncological disciplines with the goal of improving individual patient care and overall program quality. [Figure: see text]
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Affiliation(s)
- Lindsay Reddeman
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Sophie Foxcroft
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Eric Gutierrez
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Margaret Hart
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth Lockhart
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Marissa Mendelsohn
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michelle Ang
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michael Sharpe
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Padraig Warde
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Michael Brundage
- Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
| | - Lindsay Reddeman
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Sophie Foxcroft
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Eric Gutierrez
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Margaret Hart
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Elizabeth Lockhart
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Marissa Mendelsohn
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michelle Ang
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michael Sharpe
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Padraig Warde
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
| | - Michael Brundage
- Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen’s University, Kingston, Ontario, Canada
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Rooney KP, McAleese J, Crockett C, Harney J, Eakin RL, Young VAL, Dunn MA, Johnston RE, Hanna GG. The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer. Clin Oncol (R Coll Radiol) 2015; 27:514-8. [PMID: 26150375 DOI: 10.1016/j.clon.2015.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 12/25/2022]
Abstract
AIMS Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution. MATERIALS AND METHODS Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported. RESULTS One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram. CONCLUSION The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.
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Affiliation(s)
- K P Rooney
- Cancer Centre, Belfast City Hospital, Belfast, UK.
| | - J McAleese
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - C Crockett
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - J Harney
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - R L Eakin
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - V A L Young
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - M A Dunn
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - R E Johnston
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - G G Hanna
- Cancer Centre, Belfast City Hospital, Belfast, UK; Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
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Hoopes DJ, Johnstone PA, Chapin PS, Schubert Kabban CM, Lee WR, Chen AB, Fraass BA, Skinner WJ, Marks LB. Practice patterns for peer review in radiation oncology. Pract Radiat Oncol 2015; 5:32-8. [DOI: 10.1016/j.prro.2014.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/23/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
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Lymberiou T, Galuszka S, Lee G, Xu W, Fyles A, Su S, Purdie TG, Catton P, Chung C, Dinniwell R, Koch A, Levin W, Manchul L, Warde P, Liu FF. Predictors of breast radiotherapy plan modifications: Quality assurance rounds in a large cancer centre. Radiother Oncol 2015; 114:17-21. [DOI: 10.1016/j.radonc.2014.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 11/25/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
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The Impact of Peer Review of Volume Delineation in Stereotactic Body Radiation Therapy Planning for Primary Lung Cancer: A Multicenter Quality Assurance Study. J Thorac Oncol 2014; 9:527-33. [DOI: 10.1097/jto.0000000000000119] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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