Gynecologic brachytherapy

Implementation of peer-review quality rounds for gynecologic brachytherapy in a high-volume academic center:



Publication date: Available online 6 January 2020

Source: Brachytherapy

Author(s): Minh-Phuong Huynh-Le, Aaron B. Simon, David J. Hoopes, John P. Einck, Catheryn M. Yashar, Daniel Scanderbeg, Dominique Rash, Derek Brown, Loren K. Mell, Parag R. Sanghvi, Arno J. Mundt, Todd Pawlicki, Jyoti S. Mayadev

Abstract

Purpose

While peer review is critical for quality and safety in radiotherapy, there are neither formal guidelines nor format examples for brachytherapy (BT) peer review. We report on a gynecologic BT peer-review method implemented at a high-volume academic center.

Methods and Materials

We analyzed discussions at bimonthly gynecologic BT peer-review rounds between July and December 2018. Rounds consisted of 2–5 attending physicians with gynecologic BT expertise, 1–2 BT physicists, and trainees. Peer-review targets included clinical case review, contours, implant technique, dose/fractionation, and target/organ-at-risk (OAR) dosimetry. The projected/final target and OAR dosimetry were analyzed.

Results

55 separate implants from 44 patients were reviewed. Implants were mostly reviewed after the first BT fraction (n = 16, 29%) or at another time point during BT (n = 20, 36%). One (2%) implant was presented prospectively. The applicator type and BT technique were reviewed for all implants. Dose/fractionation was evaluated for 46 implants (84%); contours were discussed for 21 (38%). Target and OAR dosimetry were reviewed for 54 (98%) and 28 implants (51%), respectively. Six cases (11%) underwent minor changes to the applicator type to improve target and/or OAR dosimetry. One case (2%) had a major change recommended to the dose/fractionation.

Conclusions

Gynecologic BT peer review may enhance BT quality by allowing for implant optimization and formal review of challenging cases, ultimately improving medical decision-making and team communication. Peer review should be implemented in centers offering gynecologic BT.