Does Peer Review of Radiation Plans Affect Clinical Care? A Systematic Review of the Literature.
Peer review is a recommended component of quality assurance in radiation oncology; however, it is resource-intensive and its effect on patient care is not well understood. We conducted a systematic review of the published data to assess the reported clinical impact of peer review on radiation treatment plans.



A systematic review of published English studies was performed in accordance with the PRISMA guidelines using the MEDLINE and EMBASE databases and abstracts published from major radiation oncology scientific meeting proceedings. For inclusion, the studies were required to report the effect of peer review on ≥1 element of treatment planning (eg, target volume or organ-at-risk delineation, dose prescription or dosimetry).



The initial search strategy identified 882 potentially eligible studies, with 11 meeting the inclusion criteria for full-text review and final analysis. Across a total of 11,491 patient cases, peer review programs led to modifications in a weighted mean of 10.8% of radiation treatment plans. Five studies differentiated between major and minor changes and reported weighted mean rates of change of 1.8% and 7.3%, respectively. The most common changes were related to target volume delineation (45.2% of changed plans), dose prescription or written directives (24.4%), and non-target volume delineation or normal tissue sparing (7.5%).



Our findings suggest that peer review leads to changes in clinical care in approximately 1 of every 9 cases overall. This is similar to the reported rates of change in peer review studies from other oncology-related specialties, such as radiology and pathology.
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Kelsey
K
Brunskill
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Timothy K
TK
Nguyen
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
R Gabriel
RG
Boldt
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Alexander V
AV
Louie
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
Andrew
A
Warner
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Lawrence B
LB
Marks
Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. Electronic address: David.Palma@lhsc.on.ca.
David A
DA
Palma
D006801:Humans; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data; D058958:Organs at Risk / Q000000981:diagnostic imaging*; D018024:Peer Review, Health Care / Q000592:standards; D011785:Quality Assurance, Health Care; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards* / Q000706:statistics & numerical data*; D047368:Tumor Burden