Quality improvement in paediatric radiation oncology through peer review

Abstract

Introduction: Around 300 children in Australia and New Zealand (ANZ) undergo a course of radiation treatment (RT) each year. A fortnightly videoconference for radiation oncologists managing children started in 2013. We conducted an audit of the videoconference to assess its influence on the care of children who receive RT in ANZ. Methods: De-identified data from minutes (August 2013-December 2019) were analysed retrospectively using three categories: meeting participation, case presentations and management decisions. Results: There were 119 meetings and 334 children discussed over the six-year audit period with regular attendance from four of 11 centres treating children in ANZ. Most cases (80%) were discussed prior to RT. A change in the overall management plan was recommended for around one in eight patients (35/ 334, 13%). RT plan reviews were performed in 79 cases (23%). Adjustments were made to the target volume contours or treatment plan in 8% (6/79). Conclusion: Increasing the frequency of the meeting to weekly and compliant with the RANZCR Peer Review Audit Tool has the capacity to review all paediatric RT patients in ANZ prior to RT and initiate changes for as many as one in eight children treated by RT each year. The meeting should be considered a core component necessary to maintain expertise in paediatric RT in all centres providing RT for children in ANZ while also acting as a proton referral panel as more children are referred abroad for proton therapy before the Australian Bragg Centre for Proton Therapy opens in Adelaide in 2024.

Neurotoxicity from Old and New Radiation Treatments for Brain Tumors

“…Symptomatic brain stem injury (SBI), including pathologically verified radiation necrosis or newly appeared areas of contrast enhancement on MRI following PBT, has been reported to be either 3.8% at 2 years [ 73 ] or 2% at 5 years [ 74 ] or 3.2% as crude incidence [ 75 ]. These values are similar to those reported with standard XRT [ 76 ]. Younger age, higher radiation doses, and pre-treatment with high-dose chemotherapy are considered risk factors for SBI after PBT.…”

The impact of radiation therapist‐led structured peer review meetings on compliance to Radiation Oncology Practice Standards

“…Further studies suggested that the change rate was closer to 10% with the major change rate to be approximately 2% of reviewed cases. [21][22][23] Our study only collected data on whether there was a change recommended or not and did not distinguish between minor or major change, as per the recommended PRAT data points at the time of this study. Definitions of minor and major change have since been outlined in the revised PRAT document and applied to our prospective TPRM data collection.…”

Radiation oncology peer review in Australia and New Zealand

“…A group of paediatric ROs reported their experience of a videoconference peer review meeting between 2013 and 2019, with regular attendance from 4 of 11 centres treating children with radiation therapy across Australia and New Zealand 35 . One in six of the expected children undergoing radiotherapy across the two countries underwent peer review, with changes recommended in 13% of cases.…”

“…In Australia and internationally, peer review has been reported to improve patient care both directly and indirectly and be feasible within radiation oncology facilities 6–35 . The American Society for Radiation Oncology (ASTRO) surveyed members in 2013 to establish peer review practice patterns, 36 with the majority of the 572 participating physicians supporting formal recommendation and guidance on peer review.…”