3174 - Disease Site Specific Peer Review Highlights the Need for Prospective Contour Review for Head and Neck Treatment Planning

B. Ghavidel¹, M. Axente², E. Elder¹, M. Tavakoli¹, K. Luca², J. Holt¹, T. Gebru¹, J. C. Adams¹, R. Johnson¹, M. Cicchino¹, E. Schreibmann², and O. Kayode²; ¹Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, ²Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA

Purpose/Objective(s): Peer review among Radiation Oncology physicians is an essential step in the quality management of a patient’s treatment. Recently, our multi-site department converted from a centralized chart rounds setting, to separate disease site specific sessions, including head and neck (HN). This allowed for a more focused review of patient tumor volumes and treatment plans by a quorum of departmental disease site experts, at times resulting in subsequent plan adjustments. As one of our facilities houses a large HN practice, the local dosimetry planning load is directly affected by the number of replans that are needed post plan review. This study aimed to quantify edit requests for HN tumor volumes obtained through physician peer review and corresponding additional planning by dosimetry. Materials/

Methods: Data was collected on the number of tumor volume change requests originating from physician peer review feedback. Patient contours were reviewed at various stages in treatment planning – physician contours review only, plan complete, plan under treatment. Additionally, this study documented any additional time allocated for treatment planning amongst the dosimetry team.
Results: Within a two-month period, a total 214 patients were planned by the dosimetry team across all disease sites. Within this group, a total of 35 head and neck cases were presented at chart rounds. A total of 10 were reviewed at the contouring phase with one case requiring contour revisions (10%) resulting in no additional dosimetry work burden. The remaining 25 were not reviewed at the contouring phase, but within the planning stage. A total of 8 required changes to tumor volumes which resulted in “replan” generation by dosimetry, yielding a replan rate of 32% of cases at planning phase and total replan rate of 25.7% over all cases. With the overall time documented for replans averaging 5 hours, this added an additional 40-hour work burden on the dosimetry team.
Conclusion: Prospective contour review should be incorporated into our practice to aid in minimizing the need for HN replans. Future plans are to incorporate a hard stop MD task for tumor volume review within the patient care path to reduce the additional planning burden on the dosimetry team created by peer review change requests.