2592 - Site-Specific Peer Review: Initial Results from a Prospective Contouring and Plan Evaluation Initiative
Presenter(s)
N. A. Saeed1, L. Warren2, T. K. Kosak3, M. Kearney4, J. S. Bredfeldt5, D. Ribok6, N. E. Martin3, and S. Quirk7; 1Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 2Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, 3Brigham and Women's Hospital, Boston, MA, 4Mass General Brigham Radiation Oncoloy, Boston, MA, 5Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 6Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA, United States, 7Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): While peer review (PR) is essential to quality assurance (QA) in radiation oncology (RO), centers vary widely in evaluation structure. Moreover, systematic contour review prior to plan development is not widely implemented. In this study, we evaluated patterns in our multi-location, prospective, disease-site-specific contour and plan PR program.
Materials/Methods: We performed a retrospective analysis of all radiotherapy cases prospectively reviewed at our site-specific PR conferences since its implementation in 2024. PR took place virtually across our main academic and four community-based network practices using standardized review criteria, with a score of 1 designating no change, 2 minor revisions (optional or for future consideration), and 3 major revisions (must evaluate). Sessions are 30 minutes and were held three to five days per week depending on disease site’s patient volume. Contour review took place prior to plan generation, and plan review prior to treatment delivery. All sessions required at least two radiation oncologists and one medical physicist. Modification recommendation (MR) was defined as the proportion of cases with score 2-3. We evaluated patterns of PR using descriptive statistics and compared MR rates by disease site using chi-square analysis. Statistical significance was defined as p < 0.05.
Results: From 06/2024—1/2026, 1791 cases were reviewed, including 904 (50.5%) genitourinary (GU), 162 (9.0%) gastrointestinal (GI), 237 (13.2%) head and neck (HN), and 488 (27.2%) thoracic. Overall, 16.2% of contours and 3.4% of plans received a score of 2, while 7.9% of contours and 0.6% of plans received a score of 3. Contour MR rates were 23.0%, 22.8%, 21.6%, and 29.1% for GU, GI, HN, and thoracic, respectively. Plan MR rates were 4.2%, 4.4%, 2.4%, and 5.7% for GU, GI, HN, and thoracic, respectively. There were no statistically significant difference in MR rates by disease site for plan review (p=0.28); differences approached statistical significant for contour review (p=0.051). Indications for category 3 PR scores for both contour and plan review are shown below.
Conclusion: A disease-specific prospective structure for PR such as the one described here may be feasibly integrated across a multi-location RO network. MR rates do not appear to significantly differ by disease site. Recognizing deviations from standard practice before plan development and prior to treatment delivery may help steward treatment planning resources and improve patient outcomes
| Indications for Category 3 PR Scores | Contour Scores N (%) | Plan Scores N (%) |
| Add or modify target volumes | 80 (56.3) | 0 (0) |
| Add or modify OAR volumes | 14 (9.9) | 3 (27.3) |
| Improve target coverage | 0 (0) | 1 (9.1) |
| Reduce dose to OAR(s) | 0 (0) | 1 (9.1) |
| Change prescription dose and/or fractionation | 1 (0.7) | 0 (0) |
| Documentation error | 3 (2.1) | 2 (18.2) |
| Multiple categories recommended | 33 (23.2) | 3 (27.3) |
| Prohibitive toxicity | 0 (0) | 1 (9.1) |
| Unclassified/unspecified/other | 11 (7.7) | 0 (0) |
| Total | 142 (100%) | 11 (100%) |