PMID- 30415075
OWN - NLM
STAT- MEDLINE
DCOM- 20190405
LR  - 20190405
IS  - 1879-8519 (Electronic)
IS  - 1879-8500 (Linking)
VI  - 9
IP  - 2
DP  - 2019 Mar
TI  - Impact of Multi-Institutional Prospective Peer Review on Target and Organ-at-Risk 
      Delineation in Radiation Therapy.
PG  - e228-e235
LID - S1879-8500(18)30317-5 [pii]
LID - 10.1016/j.prro.2018.10.016 [doi]
AB  - PURPOSE: Peer review is an essential component of quality assurance programs in 
      radiation oncology. The purpose of this work was to assess whether peer reviewers 
      recommend expansion or reduction of planning target volumes (PTVs) and organs at 
      risk (OARs) in prospective multidisciplinary daily contour rounds. METHODS AND 
      MATERIALS: The peer group evaluated the appropriateness of PTVs and OARs for each 
      case according to evidence-based departmental directives. We reviewed 7645 cases 
      that presented between September 2013 and March 2017. We isolated recommendations 
      for PTV/OAR modification and classified each as expansion, reduction, both, or 
      indeterminate. Recommendations were analyzed by technique, site, and physician 
      experience. RESULTS: Eight junior and 7 senior radiation oncologists were 
      included. PTV or OAR modifications were recommended for 750 of 7645 prescriptions 
      (9.7%). The peer group recommended PTV modifications for 534 prescriptions 
      (7.0%): There were 309 expansions (57.9%), 115 reductions (21.5%), 15 both 
      (2.8%), and 95 indeterminate (17.8%). Reasons for PTV expansions included 
      increased nodal coverage and inadequate margins as a result of motion. The peer 
      group recommended OAR modifications for 216 prescriptions (2.8%): There were 102 
      expansions (47.2%), 23 reductions (10.6%), 2 both (0.9%), and 89 indeterminate 
      (41.2%). Reasons for OAR expansions included missing critical structures and 
      inadequate extent as per departmental standardization. Head and neck represented 
      the largest percentage of PTV recommendations (28.8%). Intensity modulated 
      radiation therapy plans received the most PTV and OAR recommendations (66.8% and 
      74.5%, respectively). The recommendation rate for senior and junior faculty was 
      43% and 28%, respectively. CONCLUSIONS: Peer review resulted in recommendations 
      for PTV or OAR change for approximately 10% of cases. Expansions of PTV were 
      recommended >2.5 times more often than reductions and >3 times more often than 
      OAR expansions. This general trend was identified for treatment technique, site, 
      and physician experience. Prospective peer review could yield systematically 
      larger volumes, which could affect multicenter clinical trials.
CI  - Copyright (c) 2018 American Society for Radiation Oncology. Published by Elsevier 
      Inc. All rights reserved.
FAU - Riegel, Adam C
AU  - Riegel AC
AD  - Department of Radiation Medicine, Northwell Health, Lake Success, New York; 
      Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New 
      York. Electronic address: ariegel@northwell.edu.
FAU - Vaccarelli, Marissa
AU  - Vaccarelli M
AD  - Department of Physics and Engineering Physics, Fordham University, Bronx, New 
      York.
FAU - Cox, Brett W
AU  - Cox BW
AD  - Department of Radiation Medicine, Northwell Health, Lake Success, New York; 
      Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New 
      York.
FAU - Chou, Henry
AU  - Chou H
AD  - Department of Radiation Medicine, Northwell Health, Lake Success, New York.
FAU - Cao, Yijian
AU  - Cao Y
AD  - Department of Radiation Medicine, Northwell Health, Lake Success, New York; 
      Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New 
      York.
FAU - Potters, Louis
AU  - Potters L
AD  - Department of Radiation Medicine, Northwell Health, Lake Success, New York; 
      Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New 
      York.
LA  - eng
PT  - Journal Article
DEP - 20181108
PL  - United States
TA  - Pract Radiat Oncol
JT  - Practical radiation oncology
JID - 101558279
SB  - IM
MH  - Algorithms
MH  - Evidence-Based Medicine/organization & administration
MH  - Humans
MH  - Neoplasms/*radiotherapy
MH  - Organs at Risk
MH  - *Peer Review
MH  - Program Evaluation
MH  - Prospective Studies
MH  - Quality Assurance, Health Care/*methods
MH  - Radiation Injuries/etiology/prevention & control
MH  - Radiation Oncologists
MH  - Radiation Oncology/*organization & administration
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/methods/*standards
EDAT- 2018/11/12 06:00
MHDA- 2019/04/06 06:00
CRDT- 2018/11/12 06:00
PHST- 2018/07/24 00:00 [received]
PHST- 2018/10/02 00:00 [revised]
PHST- 2018/10/30 00:00 [accepted]
PHST- 2018/11/12 06:00 [pubmed]
PHST- 2019/04/06 06:00 [medline]
PHST- 2018/11/12 06:00 [entrez]
AID - S1879-8500(18)30317-5 [pii]
AID - 10.1016/j.prro.2018.10.016 [doi]
PST - ppublish
SO  - Pract Radiat Oncol. 2019 Mar;9(2):e228-e235. doi: 10.1016/j.prro.2018.10.016. 
      Epub 2018 Nov 8.