2451 - Reducing Plan Revisions Following Peer Review Conference

Purpose/Objective(s):

Peer review conference (PRC) is an important component of safe delivery of radiation therapy. Efficient communication of PRC feedback to attendings becomes cumbersome with departmental growth. In 2020, we instituted an online third-party platform to record priority levels and comments from PRC. In March 2023, we required attending presence at one of two weekly PRC conferences where their cases were presented. The purpose of this study was to evaluate the impact of attending-assigned PRC days with a goal of reducing plan revisions and improving communication. We hypothesized there would be fewer replans and fewer cases assigned L3/L4 priority levels in the new model. Secondarily, we hypothesized resident participation would decrease replan and L3/L4 priority levels.

Materials/Methods:

For photon cases, each case during NPC was assigned a priority level and comments were recorded. Priority levels were defined as: Level 1 (L1) safe plan; 2 (L2) minor suggestion, 3 (L3) serious consideration, justification required, 4 (L4) unsafe, plan unapproved in PRC. Following PRC, attendings decided to replan or provide clarification. From Oct 2020 to Mar 2023, cases were presented in one of two weekly PRC meetings, regardless of attending’s participation. After Mar 2023, attendings were assigned to one of two PRC with required presentation of their own cases. We performed chi-square to assess L3/L4 priority levels and replan rates before and after the switch to attending-specific PRC. We also assessed impact of resident, and disease site on replan and L3/L4 priority levels.

Results:

From Oct 2020 to Jan 2026, 12,111 cases were reviewed by 22 attendings. Of these, 11,653 (93.02%) of cases were categorized as L1; 768 (6.2%) L2; 90 (0.7%) L3, 8 (0.1%) L4. Following transition to assigned attending PRC days, fewer cumulative L3/L4 scores were assigned to cases (1.04% vs 0.67%, p=0.04). The rate of replans was also reduced (1.3% vs 0.9%, p=0.03). Cases without a resident increased the risk of a L3/L4 (relative risk (RR) 2.19, p=0.0091) but was not associated with a lower risk of replan (RR 1.63, p=0.076). Genitourinary (GU) and head and neck (HN) saw a reduction in L3/L4 (GU: 1.82% vs 0.45% (P= 0.028); (HN: 2.12% vs 0.59%, 0.035) but no other sites significantly changed. Following March 2023, if a case was presented in the alternate conference not assigned to the attending, more L3/L4 scores were observed (1.1% vs 0.52%, p=0.006) but similar replan rates were observed.

Conclusion:

Attending assigned PRC was associated with fewer L3/L4 classifications and reduced replanning. This is a clinically meaningful reduction in replans due to the intensive resources required for a revision. The reduction is likely due to improved communication of planning goals and clinical details from treating attendings and residents to the audience. Next steps include triaging appropriate patients at high risk of replan and automating aspects of PRC for low-risk cases unlikely to be replanned.