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Top Line: How should we structure physician peer-review in radiation oncology? 

The Study: Weekly chart rounds in radiation oncology typically involves a group of rad oncs casually observing dosimetrists or residents click through new treatment plans (plus or minus donuts). It is an important opportunity to detect errors in the treatment planning process before patients start treatment. In this blinded, prospective study, 20 sham treatment plans were generated by a clinical team to represent common planning errors identified in the Radiation Oncology Incident Learning System (RO-ILS). The planning errors were specifically designed to be detectable and serious enough that a peer would recommend changing the plan. Two erroneous plans were mixed into each weekly meeting. The overall detection rate was 55%, which varied according to the type of error. For example, 100% of errors in accounting for prior treatment were detected compared to only 50% of errors involving a wrong target or wrong dose—eesh. More interesting was that the detection rate dropped from 75% for plans presented in the first 30 minutes of chart rounds to 25% after 30 minutes. Conversely, average time per case, number of cases presented, and number of physicians present didn’t influence detection rate. Finally, few detections were made (at least publicly) by non-attending physicians.

TBL: Have some coffee with those donuts because the detection rate of treatment planning errors during radiation oncology peer review varies by type of error and the duration of peer-review sessions. | Talcott, Pract Radiat Oncol 2020

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