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. 2023:22:e60.
doi: 10.1017/s1460396922000309. Epub 2022 Nov 4.

Head and neck radiotherapy quality assurance conference for dedicated review of delineated targets and organs at risk: results of a prospective study

J C Farris  1 , N B Razavian  1 , M K Farris  1 , J D Ververs  1 , B A Frizzell  1 , C M Leyrer  1 , L F Allen  1 , K M Greven  1 , R T Hughes  1
Affiliations

Head and neck radiotherapy quality assurance conference for dedicated review of delineated targets and organs at risk: results of a prospective study

J C Farris et al. J Radiother Pract. 2023.

Abstract

Purpose: Head and neck (HN) radiotherapy (RT) is complex, involving multiple target and organ at risk (OAR) structures delineated by the radiation oncologist. Site-agnostic peer review after RT plan completion is often inadequate for thorough review of these structures. In-depth review of RT contours is critical to maintain high-quality RT and optimal patient outcomes.

Materials and methods: In August 2020, the HN RT Quality Assurance Conference, a weekly teleconference that included at least one radiation oncology HN specialist, was activated at our institution. Targets and OARs were reviewed in detail prior to RT plan creation. A parallel implementation study recorded patient factors and outcomes of these reviews. A major change was any modification to the high-dose planning target volume (PTV) or the prescription dose/fractionation; a minor change was modification to the intermediate-dose PTV, low-dose PTV, or any OAR. We analysed the results of consecutive RT contour review in the first 20 months since its initiation.

Results: A total of 208 patients treated by 8 providers were reviewed: 86·5% from the primary tertiary care hospital and 13·5% from regional practices. A major change was recommended in 14·4% and implemented in 25 of 30 cases (83·3%). A minor change was recommended in 17·3% and implemented in 32 of 36 cases (88·9%). A survey of participants found that all (n = 11) strongly agreed or agreed that the conference was useful.

Conclusion: Dedicated review of RT targets/OARs with a HN subspecialist is associated with substantial rates of suggested and implemented modifications to the contours.

Keywords: chart rounds; head and neck; peer review; quality assurance; radiation; radiotherapy.

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Conflict of interest statement

Competing Interests. The author(s) declare none

Figures

Figure 1.
Figure 1.
(a) Definitions of major and minor changes used for the prospective data collection of HN RT QAC cases. (b) Per cent of cases in which major or minor changes were suggested. (c) Per cent of cases in which major and minor changes were implemented by the treating physician.
Figure 2.
Figure 2.
(a) Distribution of the types of major changes recorded. (b) Distribution of the types of minor changes recorded.
See this image and copyright information in PMC

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