TY - JOUR
T1 - Evaluation of a prospective radiation oncology departmental team review process using standardized simulation directives
AU - Kutuk, Tugce
AU - LeGrand, Lorrie A.
AU - Valladares, Maria A.
AU - Rubens, Muni
AU - Chisem, Monique
AU - Quintana, Gabriella
AU - Appel, Haley
AU - Chuong, Michael D.
AU - Hall, Matthew D.
AU - Contreras, Jessika A.
AU - Fagundes, Marcio
AU - Gutierrez, Alonso N.
AU - Mehta, Minesh P.
AU - Kotecha, Rupesh
N1 - Funding Information:
Part of this work presented in an oral presentation at the 63rd ASTRO Annual Meeting. The authors appreciate the individuals who were instrumental to the creation of the “morning huddle” operations meeting and their participation, including Joseph Panoff, Noah Kalman, Maria-Amelia Rodrigues, Albert Lewin, Steven Olszewski, Andre Abitbol, Mayney Gavilondo, George Godfrey, Steven Holan, Michele Ryder, Ulrich Ramos, Kristin Morris, Gus Luciani, Ranjini Tolakanahalli, D Jay Wieczorek, Vivek Mishra, Lauren Suarez, Michael Rawlins, and Maytee Diaz-Williams. The authors appreciate Lisa Rosen for her assistance with a medical writing review.
Funding Information:
Michael D. Chuong: Grants, personal fees, and nonfinancial support from ViewRay, personal fees and nonfinancial support from Sirtex, personal fees and nonfinancial support from Accuray, and grants from AstraZeneca.
Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/5
Y1 - 2022/5
N2 - 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.
AB - 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.
KW - Quality
KW - Radiotherapy
KW - Simulation
KW - Team review
KW - Telemedicine
UR - http://www.scopus.com/inward/record.url?scp=85128216517&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2021.12.028
DO - 10.1016/j.radonc.2021.12.028
M3 - Article
C2 - 34971659
AN - SCOPUS:85128216517
SN - 0167-8140
VL - 170
SP - 102
EP - 110
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -