Evaluation of a prospective radiation oncology departmental team review process using standardized simulation directives

Tugce Kutuk, Lorrie A. LeGrand, Maria A. Valladares, Muni Rubens, Monique Chisem, Gabriella Quintana, Haley Appel, Michael D. Chuong, Matthew D. Hall, Jessika A. Contreras, Marcio Fagundes, Alonso N. Gutierrez, Minesh P. Mehta, Rupesh Kotecha

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: The primary objective of this study is to evaluate the utility and value of an institutional, multi-disciplinary radiation oncology team review process prior to radiotherapy (RT) simulation. Methods: Over a period of 3 months and through an iterative team-based process, a standardized simulation requisition directive (SSRD) was developed, piloted, modified, and subsequently implemented for all patients treated with external beam RT at a single tertiary care institution from January to December 2020. The SSRDs were reviewed at a daily multi-disciplinary radiation oncology team review conference; modifications consequential to the review were prospectively recorded in a quality database. Results: 1500 consecutive SSRDs were prospectively reviewed for this study. 397 modifications on 290 (19.3%) SSRDs were recorded and parsed into 5 main categories and 18 subcategories. The most common modifications resulted from changes in immobilization device (n = 88, 22.2%), RT care path (n = 56, 14.1%), and arm positioning (n = 43, 10.8%). On univariate analysis, modifications were associated with RT intent, scan parameters, tumor site, and consultation type. An increased rate modifications was observed for patients had telemedicine consults (n = 101, 22.7%) compared to in-person consultations (n = 189, 17.9%) (p = 0.032). Using logistic regression analysis, there was also a statistically significant relationship between postoperative RT delivery and modification rates (OR: 2.913, 95% CI: 1.014–8.372) (p = 0.0126). Overall, only 14 patients (0.9%) needed re-simulation during the entire study period. Conclusions: Prospective multi-disciplinary radiation oncology team review prior to simulation identifies actionable change in approximately 19% of procedures, and results in an extremely low rate (<1%) of re-simulation. As departmental processes transition to virtual platforms, thorough attention is needed to identify patients at higher risk of simulation modifications.

Original languageEnglish
Pages (from-to)102-110
Number of pages9
JournalRadiotherapy and Oncology
StatePublished - May 2022


  • Quality
  • Radiotherapy
  • Simulation
  • Team review
  • Telemedicine


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