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. 2024 Jul 3:48:100816.
doi: 10.1016/j.ctro.2024.100816. eCollection 2024 Sep.

Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility

Yew Sin  1 , Vikneswary Batumalai  2   3 , Jeremy de Leon  2 , Eugene Leong  4   5 , Kasri Rahim  4   5 , Farshad Kasraei  2 , Charles Tran  2 , Tommy Liang  4 , Katrina Biggerstaff  4 , Michael G Jameson  2   6 , Nicole Hug  4 , Kathryn Hird  1 , Hendrick Tan  4   5
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Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility

Yew Sin et al. Clin Transl Radiat Oncol. .

Abstract

Background and purpose: Peer review is an important component of quality assurance in radiotherapy. To our knowledge, there are no studies reporting on the feasibility and outcomes of the peer review process for magnetic resonance (MR) guided radiotherapy (MRgRT) on the MR linear accelerator (MR-Linac) despite the planning complexity involved and its evolving clinical indications. This study aimed to quantify the rate of change in treatment plans post-peer review and the time and resources required.

Materials and methods: Fifty-five cases presented at weekly MR-Linac peer review meetings across two centres from 8 June to 21 September 2023 were prospectively collected. Cases were analysed to determine the rate and extent of plan changes based on the Peer Review Audit Tool for radiation oncology (PRAT) developed by the Royal Australian and New Zealand College of Radiologists (RANZCR).

Results: Peer review resulted in changes to 36.4 % of treatment plans (n = 20), with 3.6 % (n = 2) having major changes requiring deferment of treatment. The most frequent changes were to organs at risk (OAR) volumes involving both delineation and increased OAR sparing (16.4 %, n = 9), total dose and fractionation (10.9 %, n = 6) and target volume dose coverage (5.5 %, n = 3). Patients with SBRT plans (39.1 % cf 22.2 %), oligometastatic/oligoprogressive sites (38.1 % cf 30.7 %) and reirradiation cases (41.2 % cf 34.2 %) had higher rates of change. Cases took a mean of 7 min (range 2-15 minutes) to discuss.

Conclusion: The high rates of plan changes support the value of peer review in MRgRT. We recommend, where possible that all MRgRT cases, particularly those involving SBRT plans, oligometastatic/oligoprogressive sites, and/or reirradiation, be subject to peer review.

Keywords: Adaptive radiotherapy; MR-guided radiotherapy; MR-linac; Peer Review; Quality assurance; Radiation Oncology; Radiotherapy; Reirradiation; Stereotactic ablative body radiation therapy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
T2 navigated MRI scan of a patient with metastatic rectal adenocarcinoma with oligoprogressive segment 2 liver metastasis. Original stomach contour is denoted by dark red line. Pink, green and dark blue contours denote GTV, ITV and PTV. Turquoise line shows corrected stomach contour after peer review.
See this image and copyright information in PMC

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