Pilot study of radiation oncology peer review in low middle income country (LMIC) through cloud-based platform

Purpose: Peer review is an essential step in clinical quality assurance for radiation therapy. There are very little data on peer reviews from low-middle-income countries (LMIC). With increasing access to advanced technologies in LMIC also, peer review is becoming more important to ensure quality and standard of care. We evaluated cloud-based e-Peer review in our network of cancer centers in India with an aim to study its feasibility and impact on care.

Materials and methods: Four out of 13 cancer centers across India were selected for this pilot study. All team members were trained on the e-Peer review platform before the initiation of the study. A lead dosimetrist from a centralized planning site was selected to share new cases every week. Cases treated with only definitive intent were selected. The link to the cases was sent through an email to reviewing physicians. The following aspects were reviewed for each case. 1) Work up and staging. 2) Treatment intent and prescription. 3) Target contours. 4) Normal organ at risk contours. 5) Dose-volume-histogram (DVH) with clinical goals attached. Cases were marked as "Not Appropriate," "Appropriate," "Appropriate with minor finding," and "Represent with major revisions" as per volume and plan review.

Results: Over a period of 3 months, 100 cases underwent peer review before the start of treatment. Median turnover time was 48 (interquartile range: 24-96) hours. The median time for review was 8 min with time to review cases requiring major and minor changes being 12 and 6 min, respectively (P < 0.001). Of all the cases reviewed, no changes, minor changes, and major changes were suggested for 36%, 48%, and 16% of cases, respectively. The most frequent reason for major changes was contouring corrections (15%). Also, 31.3% of major changes underwent recontouring and replanning before initiation of treatment.

Conclusion: Peer review was feasible in our setting through this cloud-based peer review system, with median turnover time and time taken for review being 48 h and 8 min, respectively. Like published data from the Western world, peer review led to changes that could impact patient care delivery and outcome. We plan to implement this across the remaining centers in our network.