title: The Impact of Colleague Peer Review on the Radiotherapy Treatment Planning Process in the Radical Treatment of Lung Cancer.
abstract: OBJECTIVE
  Modern radiotherapy uses techniques to reliably identify tumour and reduce target volume margins. However, this can potentially lead to an increased risk of geographic miss. One source of error is the accuracy of target volume delineation (TVD). Colleague peer review (CPR) of all curative-intent lung cancer plans has been mandatory in our institution since May 2013. At least two clinical oncologists review plans, checking treatment paradigm, TVD, prescription dose tumour and critical organ tolerances. We report the impact of CPR in our institution.
  
  
  METHODS
  Radiotherapy treatment plans of all patients receiving radical radiotherapy were presented at weekly CPR meetings after their target volumes were reviewed and signed off by the treating consultant. All cases and any resultant change to TVD (including organs at risk) or treatment intent were recorded in our prospective CPR database. The impact of CPR over a 13 month period from May 2013 to June 2014 is reported.
  
  
  RESULTS
  One hundred and twenty-two patients (63% non-small cell lung carcinoma, 17% small cell lung carcinoma and 20% 'clinical diagnosis') were analysed. On average, 3.2 cases were discussed per meeting (range 1-8). CPR resulted in a change in treatment paradigm in 3% (one patient proceeded to induction chemotherapy, two patients had high-dose palliative radiotherapy). Twenty-one (17%) had a change in TVD and one (1%) patient had a change in dose prescription. In total, 6% of patients had plan adjustment after review of dose volume histogram.
  
  
  CONCLUSIONS
  The introduction of CPR in our centre has resulted in a change in a component of the treatment plan for 27% of patients receiving curative-intent lung radiotherapy. We recommend CPR as a mandatory quality assurance step in the planning process of all radical lung plans.
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK. Electronic address: keith.rooney@belfasttrust.hscni.net.
authors.forename: K P
authors.initials: KP
authors.lastname: Rooney
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: J
authors.initials: J
authors.lastname: McAleese
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: C
authors.initials: C
authors.lastname: Crockett
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: J
authors.initials: J
authors.lastname: Harney
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: Eakin
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: V A L
authors.initials: VA
authors.lastname: Young
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Dunn
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Johnston
authors.affiliation: Cancer Centre, Belfast City Hospital, Belfast, UK; Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK.
authors.forename: G G
authors.initials: GG
authors.lastname: Hanna
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008875:Middle Aged; D010347:Patient Care Planning / Q000592:standards; D018024:Peer Review, Health Care; D011785:Quality Assurance, Health Care; D011878:Radiotherapy / Q000592:standards*
keywords: Non-small cell lung cancer; peer review; quality assurance; radiotherapy; target volume delineation