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New ASTRO white paper recommends peer review to increase quality assurance and safety

The American Society for Radiation Oncology (ASTRO) has issued a new white paper, "Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive Summary," that recommends increased peer review within the radiation therapy treatment process and among members of the radiation oncology team in order to increase quality assurance and safety, according to the manuscript published as an article in press online in Practical Radiation Oncology (PRO), the official clinical practice journal of ASTRO. The executive summary and supplemental material are available online immediately as open-access articles ( and will be published in a 2013 print edition of PRO.

Commissioned by ASTRO's Board of Directors as part of ASTRO's Target Safely campaign, the white paper focuses on the vital role of patient-specific peer review throughout many areas within radiation therapy and how peer review related to professional decisions made by members of the radiation oncology team might improve patient safety and quality of care. The report details suggested targets for peer review throughout the evaluation, planning and treatment processes. Importantly, the report prioritizes the targets that are most likely to have a meaningful impact on patient outcome, e.g., the decision to include radiation as part of the multi-modality approach; imaging/immobilization technique; image segmentation; planning and optimization; plan preparation; and treatment set-up. The paper identifies the potential benefits of the peer review process and recommends methods to overcome possible barriers to peer review, particularly for small, single-provider centers, such as online virtual networking tools and other technologies and forums that provide opportunities for the "peer review-at-a-distance" paradigm.

"This white paper focuses on peer review for medical decision-making and technical expertise, for which there has been little guidance previously," said Lawrence B. Marks, MD, FASTRO, the Dr. Sidney K. Simon Distinguished Professor of Oncology Research and chairman of the department of radiation oncology at the University of North Carolina at Chapel Hill. "Peer review ideally should be a routine component of clinical practice and our residency training programs. With strong leadership, clearly defined goals and guidelines, and dedicated time and resources, the peer review process can foster a practice environment that builds collaborative relationships among members of the treatment team, enhances our culture of safety within radiation oncology and reaffirms to patients our commitment to safety and quality of care."

The full text document (Supplemental Material) was approved by the ASTRO Board of Directors on September 11, 2012, and has been endorsed by the American Association of Physicists in Medicine (AAPM), American Association of Medical Dosimetrists (AAMD) and the American Society of Radiologic Technologists (ASRT). It has also been reviewed and accepted by the American College of Radiology's (ACR) Commission on Radiation Oncology. This white paper is related to other published reports in the ASTRO white paper series on patient safety, including those on intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT).


Contact: Michelle Kirkwood
American Society for Radiation Oncology

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