A117: Quality Assurance (QA) of Radiotherapy Planning: Optimising the Peer Review process in a Canadian Cancer Centre
1Tom Baker Cancer Centre, Calgary,Alberta, Canada
The Canadian Partnership for Quality Radiotherapy (CPQR) Quality Assurance Guidelines1 recommend radiation oncologist (RO) peer review of radiotherapy (RT) plans prior to radiotherapy delivery or within 25% of a treatment course. The Tom Baker Cancer Centre, Calgary holds seven disease-site specific, 1-hour weekly peer review QA meetings but outcomes were not routinely documented.
Outcomes of each case reviewed at (i)Breast, (ii)Head and Neck/Thyroid/Cutaneous and (iii)Lung tumour QA rounds from Jan 6 to May 5, 2015 were recorded prospectively. Each radiotherapy (RT) plan was assigned an outcome: A (no change required), B (issue to consider for future patients), or C (change required before next fraction) as previously described2. The timing of QA relative to RT start-date, whether recommendations were initiated, whether changes could have been detected at the contouring stage and a description of each B or C deviation were recorded.
211 RT plans prescribed by 20 ROs were peer-reviewed at 43 QA meetings. 93% were curative plans and 7% palliative. A median of 4 ROs were present for each discussion. 97% of plans were reviewed before 25% of the treatment course was delivered with 72% before the RT start-date. 28% were reviewed after contouring (prior to plan development) and 72% were reviewed after plan approval. For plans reviewed post-contouring, 26% had a B and 10% had a C outcome.. For post-planning reviews the B and C rates were 12% and 9%, respectively. 88% of C outcomes resulted in plan changes prior to further RT. Only 55% of C deviations would have been detected at the post-contouring stage.
Routine peer review of RT plans improved plan quality prior to treatment delivery. Timing of peer review at the post-contouring stage would have failed to detect 45% of C outcomes and therefore peer review after plan completion is recommended.