title: Detailed prospective peer review in a community radiation oncology clinic.
abstract: OBJECTIVE
  In 2012, we instituted detailed prospective peer review of new cases. We present the outcomes of peer review on patient management and time required for peer review.
  
  
  METHODS
  Peer review rounds were held 3 to 4 days weekly and required 2 physicians to review pertinent information from the electronic medical record and treatment planning system. Eight aspects were reviewed for each case: 1) workup and staging; 2) treatment intent and prescription; 3) position, immobilization, and simulation; 4) motion assessment and management; 5) target contours; 6) normal tissue contours; 7) target dosimetry; and 8) normal tissue dosimetry. Cases were marked as, "Meets standard of care," "Variation," or "Major deviation." Changes in treatment plan were noted. As our process evolved, we recorded the time spent reviewing each case.
  
  
  RESULTS
  From 2012 to 2014, we collected peer review data on 442 of 465 (95%) radiation therapy patients treated in our hospital-based clinic. Overall, 91 (20.6%) of the cases were marked as having a variation, and 3 (0.7%) as major deviation. Forty-two (9.5%) of the cases were altered after peer review. An overall peer review score of "Variation" or "Major deviation" was highly associated with a change in treatment plan (P < .01). Changes in target contours were recommended in 10% of cases. Gastrointestinal cases were significantly associated with a change in treatment plan after peer review. Indicators on position, immobilization, simulation, target contours, target dosimetry, motion management, normal tissue contours, and normal tissue dosimetry were significantly associated with a change in treatment plan. The mean time spent on each case was 7 minutes.
  
  
  CONCLUSIONS
  Prospective peer review is feasible in a community radiation oncology practice. Our process led to changes in 9.5% of cases. Peer review should focus on technical factors such as target contours and dosimetry. Peer review required 7 minutes per case.
authors.affiliation: Joint Radiation Oncology Center, David Grant Medical Center, Travis Air Force Base, California. Electronic address: james.mitchell.6@us.af.mil.
authors.forename: James D
authors.initials: JD
authors.lastname: Mitchell
authors.affiliation: U.S. Census Bureau, Washington, DC.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Chesnut
authors.affiliation: Joint Radiation Oncology Center, David Grant Medical Center, Travis Air Force Base, California.
authors.forename: David V
authors.initials: DV
authors.lastname: Eastham
authors.affiliation: Joint Radiation Oncology Center, David Grant Medical Center, Travis Air Force Base, California.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: Demandante
authors.affiliation: Department of Radiation Oncology, University of California San Diego, San Diego, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Hoopes
mesh_terms: D006801:Humans; D018024:Peer Review, Health Care; D011446:Prospective Studies; D018787:Radiation Oncology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted