Disease site-specific Peer Review Implementation: From Chart Rounds to the Treatment Couch

Abstract Purpose The impact of disease site–specific peer review on radiation treatment planning recommendations is not well understood. We implemented a standardized peer review checklist to evaluate factors influencing recommendations and their implementation during disease-site specific peer review. Methods A 7-item checklist was completed prospectively during weekly or bi-weekly meetings in four disease site-specific peer review groups including (1) radiation approach, (2) dose/fractionation (3) prescription accuracy, (4) organ-at-risk (OAR) contours, (5) target volumes, (6) plan quality evaluations, and (7) setup imaging. Review comments were divided into (A) education/discussion without change recommendation, (B) minor suggestion/optional modifications, or (C) major comment requiring plan modification. Rates of comment types and implementation of plan changes were tracked. Statistical analysis was conducted using two-proportion Z-test, Welch's t-tests and ANOVA. Results A total of 1,311 peer reviews in 914 unique patients were recorded over 6 months. Average review duration was 2 minutes 32 seconds with significant differences (p<0.01) across disease site groups. There were 286 total comments: 259(21.8%) category A, 26(2%) category B, and 1(<1%) category C. The proportion of cases generating comments varied by disease site (10–34%), with only a subset resulting in implemented plan changes (0–25.8% of comments). Most implemented changes involved target volumes, OAR contours, and patient setup. Cases undergoing multiple reviews were more likely to generate comments than cases with a single review (25.0% vs 13.0%, p<0.01). Furthermore, cases with multiple reviews were significantly more likely to have implemented plan changes compared with single-review cases (28.9% vs 1.2%, p<0.01). Conclusion We successfully implemented a peer review checklist in the context of disease site-specific peer review meetings. There is significant variability in comments and their implementation across checklist items and disease site groups. Iterative review significantly increased the probability of treatment plan changes.