Peer review program to enhance treatment planning quality assurance for community radiation oncologists

Objective Many cancer patients are treated at treatment centers staffed by community radiation oncologists (CRO). Patients choose these facilities for location convenience and anticipate equivalent care to “high volume” centers despite contrary literature. Local CROs hypothesized that a two-step quality assurance (QA) program that added early contour and case review would improve confidence in radiation treatment plan quality and reduce variability across facilities. Methods Five physicians at five academic satellites participated in the pilot two-step QA program. This program established an efficient, secure, HIPPA compliant workflow to review case details and contours on CT simulation after uploading to a remote access server on a commercially available platform. Results Over 12 months, 148 patient contours were reviewed by at least one CRO with an average of 2 reviewers per case. Reviewers approved 67% without change, requested clarification or change in 28%, and would not approve 4% of cases unless revised. The most common reasons cited for change request were “review GTV—volume increase” and “review CTV—volume increase.” Eighty-eight percent of treated cases that were not approved initially subsequently completed recommended modifications. Published literature was shared for 29% cases and sub-specialist consulted for 19% of cases. Conclusion A two-step QA program was considered highly valuable by all participants allowing easily implanted mechanisms for standardization, higher case volume, and shared educational resources for small academic satellite CROs who are faced with the challenge of caring for a diverse community cancer population. Feasibility suggests the model could serve as a model for other CRO.