B. Mbarek, S. Karuppu, D. Tran, and H. Karthikeyan; FV hospital Far east medical, H? Chí Minh, Viet Nam
Purpose/Objective(s): In the department radiation oncology (RO) in FV hospital , HCMC Vietnam, the physicists had different training backgrounds and curriculums. Consequently, the planning quality was operator dependent and disparities persisted between dosimetries. Peer Reviewing (PR) is one of the QA strategies that has been proven helpful to avoid errors and reduce disparities. A PR process was implemented in the department in order to standardize the practice. To our best knowledge, this is the first experience of implementation of peer review and evaluation of its impact on quality of planning and practice harmonization in Vietnam. Materials/
Methods: A prospective systematic peer review of treatment plans was initiated, using an in house spreadsheet software Peer Review Form (PRF). Data from dosimetry cases generated by both planning systems in use in our department for the 10 most treated sites were entered. PRF included a checklist for imaging, Fusion, Contouring, planning & dosimetry score cards. Once plan is ready, the initial planner enters all the above data in the checklist. Then a peer reviews the plan. During the plan evaluation PR meeting, the compliance of the plan to the department success criteria were checked and the peer will feed back to the planner suggestions of plan improvement if any. The plan would be then classified into a) No change b) Minor Changes C) Rejected The impact of peer review was evaluated over a period of 12 months. Results: Data was prospectively collected for 300 patient peer reviewed plans. Patients treated with VMAT technique - 206 (69%), SBRT-28(9%), 3DCRT-66(22%). Patients’ treatment intent was curative in 203 cases (67%), and Palliative in 97(33%) cases. Time spent on Peer review for curative & palliative treatment plans was13.8 minutes (min) (range 13-25 min) and 9.1 min (range 5-18 min) respectively. Average duration of peer review with respect to treatment type was: VMAT 12.6 (5-20) min, SBRT 23.4 (20-25) min, 3DCRT 9 (5-15) min. The peer review feedback, allowed to classify the plans into plans accepted without any modification in 263 cases (87.6%), plans accepted with minor correction in 17 cases (5.6%),and plans rejected and recommended for replan in 20 cases (6.6%). The reasons of plan rejection were lack of target coverage, need to reduce treatment duration & need to reduce low doses spillage and doses to organs at risk in 14(70%), 3(15%),3(15%) respectively. The number of rejected plans reduced over time going from 18% of the cases in the first three months to 4% in the last 3 months of the study which reveals a trend towards harmonization of the planning practice in the department. Conclusion: Radiotherapy plans peer review is an important learning tool for planners, in our single institution experience it had an impact on planning quality improvement and harmonization of the good practice. In our experience it was not a time consuming process. we suggest peer review data to be used as a Quality Indicator for RO department that helps monitor practice improvement.
