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Abstract：
BACKGROUND: Peer review (PR) of palliative-intent radiation plans is an important but understudied component of quality assurance. This retrospective review aims to improve our understanding of palliative PR by examining the characteristics of reviewed plans and peer feedback along with the associated time burden of two different types of PR processes.
METHODS: This single-institution, quality assurance project assessed palliative PR between 2018 and 2020. Initially, the PR involved a multi-disciplinary team PR. Subsequently, it transitioned to independent PR by a single physician. Characteristics of reviewed plans and feedback on PR were captured and abstracted. Time requirements of PR were based on self-reported estimates and attendance records.
RESULTS: A total of 1942 cases were reviewed, representing 85.7% (1942/2266) of all palliative-intent plans between 2018 and 2020. A total of 41.1% (n=799) were simple (2D/3D) radiation plans while 56.0% (n=1087) were complex (volumetric modulated arc therapy (VMAT) or tomotherapy) plans. Approximately one-third (30.4%, n=590) of all plans were stereotactic treatments. The rate of any peer feedback was 2.3% (n=45), while the rate of a specific recommended or implemented change was 1.2% (n=24) and 0.9% (n=18), respectively. PR before the start of treatment was associated with more frequent recommended (p=0.005) and implemented changes (p=0.008). Most other factors, including plan complexity and use of stereotactic radiation, were not predictive in this analysis. Comparing the independent versus team PR approach, there was no significant difference in recommended or implemented changes. The mean±standard deviation (SD) staff time required per plan reviewed was 36±6 and 37±6 minutes, including 21±6 and 10±6 minutes of physician time, for team and independent PR, respectively.
CONCLUSIONS: This work highlights the high frequency of complex and stereotactic radiation in the palliative setting, along with the importance of timely PR and the potential benefit of reviewing even simple, 2D/3D radiation plans. Additionally, from a process perspective, our work showed that independent PR may require less dedicated physician time.
METHODS: This single-institution, quality assurance project assessed palliative PR between 2018 and 2020. Initially, the PR involved a multi-disciplinary team PR. Subsequently, it transitioned to independent PR by a single physician. Characteristics of reviewed plans and feedback on PR were captured and abstracted. Time requirements of PR were based on self-reported estimates and attendance records.
RESULTS: A total of 1942 cases were reviewed, representing 85.7% (1942/2266) of all palliative-intent plans between 2018 and 2020. A total of 41.1% (n=799) were simple (2D/3D) radiation plans while 56.0% (n=1087) were complex (volumetric modulated arc therapy (VMAT) or tomotherapy) plans. Approximately one-third (30.4%, n=590) of all plans were stereotactic treatments. The rate of any peer feedback was 2.3% (n=45), while the rate of a specific recommended or implemented change was 1.2% (n=24) and 0.9% (n=18), respectively. PR before the start of treatment was associated with more frequent recommended (p=0.005) and implemented changes (p=0.008). Most other factors, including plan complexity and use of stereotactic radiation, were not predictive in this analysis. Comparing the independent versus team PR approach, there was no significant difference in recommended or implemented changes. The mean±standard deviation (SD) staff time required per plan reviewed was 36±6 and 37±6 minutes, including 21±6 and 10±6 minutes of physician time, for team and independent PR, respectively.
CONCLUSIONS: This work highlights the high frequency of complex and stereotactic radiation in the palliative setting, along with the importance of timely PR and the potential benefit of reviewing even simple, 2D/3D radiation plans. Additionally, from a process perspective, our work showed that independent PR may require less dedicated physician time.
摘要：
背景：姑息性放射计划的同行评审（PR）是质量保证的重要但未得到充分研究的组成部分。这项回顾性审查旨在通过审查计划和同行反馈的特征以及两种不同类型的PR过程的相关时间负担，来提高我们对姑息性PR的理解。
方法：这个单一机构，质量保证项目在2018年至2020年期间评估了姑息性PR。最初，公关涉及一个多学科的公关团队。随后，它由一名医生过渡到独立的PR。捕获并抽象了已审查计划的特征和对PR的反馈。PR的时间要求基于自我报告的估计和出勤记录。
结果：共审查了1942例病例，占2018年至2020年所有姑息治疗计划的85.7%（1942/2266）。总共有41.1％（n=799）是简单的（2D/3D）放射计划，而56.0％（n=1087）是复杂的（体积调制电弧治疗（VMAT）或断层治疗）计划。大约三分之一(30.4%，n=590）的所有计划均为立体定向治疗。任何同伴反馈的比率为2.3%(n=45)，而具体建议或实施的变更率为1.2%(n=24)和0.9%(n=18)，分别。开始治疗前的PR与更频繁的推荐变化（p=0.005）和实施变化（p=0.008）相关。大多数其他因素，包括计划的复杂性和立体定向辐射的使用，在这次分析中没有预测性。比较独立与团队公关方法，推荐或实施的变更没有显著差异.每个计划审查所需的平均±标准差（SD）员工时间为36±6和37±6分钟，包括21±6和10±6分钟的医生时间，对于团队和独立公关，分别。
结论：这项工作突出了在姑息环境中复杂和立体定向辐射的高频率，除了及时公关的重要性和复习甚至简单的潜在好处之外，2D/3D辐射计划。此外,从过程的角度来看，我们的工作表明,独立公关可能需要较少的专职医师时间.
方法：这个单一机构，质量保证项目在2018年至2020年期间评估了姑息性PR。最初，公关涉及一个多学科的公关团队。随后，它由一名医生过渡到独立的PR。捕获并抽象了已审查计划的特征和对PR的反馈。PR的时间要求基于自我报告的估计和出勤记录。
结果：共审查了1942例病例，占2018年至2020年所有姑息治疗计划的85.7%（1942/2266）。总共有41.1％（n=799）是简单的（2D/3D）放射计划，而56.0％（n=1087）是复杂的（体积调制电弧治疗（VMAT）或断层治疗）计划。大约三分之一(30.4%，n=590）的所有计划均为立体定向治疗。任何同伴反馈的比率为2.3%(n=45)，而具体建议或实施的变更率为1.2%(n=24)和0.9%(n=18)，分别。开始治疗前的PR与更频繁的推荐变化（p=0.005）和实施变化（p=0.008）相关。大多数其他因素，包括计划的复杂性和立体定向辐射的使用，在这次分析中没有预测性。比较独立与团队公关方法，推荐或实施的变更没有显著差异.每个计划审查所需的平均±标准差（SD）员工时间为36±6和37±6分钟，包括21±6和10±6分钟的医生时间，对于团队和独立公关，分别。
结论：这项工作突出了在姑息环境中复杂和立体定向辐射的高频率，除了及时公关的重要性和复习甚至简单的潜在好处之外，2D/3D辐射计划。此外,从过程的角度来看，我们的工作表明,独立公关可能需要较少的专职医师时间.
