title: Importance of patient examination to clinical quality assurance in head and neck radiation oncology.
abstract: BACKGROUND
  When quality assurance programs in clinical radiation oncology focus mainly on the technical aspects of treatment, they tend to underplay questions of therapeutic process and outcome. We determined the value of clinical peer review in radiation therapy for head and neck cancer that involved head and neck examination.
  
  
  METHODS
  Data were collected prospectively on 134 consecutive patients with preliminary radiation therapy (RT) plans. Peer review was performed that included head and neck examination and imaging review to confirm target localization.
  
  
  RESULTS
  Peer review led to changes in treatment plans for 66% of patients. Most changes were minor, but 11% of changes were major and thought to be of a magnitude that could potentially affect therapeutic outcome or normal tissue toxicity. Most changes involved target delineation based on physical findings
  
  
  CONCLUSIONS
  Peer review of radiation target localization in RT plans led to changes that could potentially affect rates of cancer control or complication in about 10% of patients. We suggest that the accuracy of head and neck radiation oncology treatment plans might be increased by co-examination by another head and neck cancer specialist, typically a radiation oncologist or head and neck surgeon, to confirm RT target volumes.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. dirosenthal@mdanderson.org
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Asper
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Barker
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: K S Clifford
authors.initials: KS
authors.lastname: Chao
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: K Kian
authors.initials: KK
authors.lastname: Ang
mesh_terms: D002983:Clinical Competence; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D018024:Peer Review, Health Care; D010808:Physical Examination; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods*; D018787:Radiation Oncology / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted; D013679:Technology, Radiologic