S1506
Interdisciplinary - Quality assurance and risk management
ESTRO 2026
Stephanie Tanadini-Lang, Lotte Wilke, Klara Kefer, Sara Abdollahi, Indira Madani, Filipa Branco, Izabela Pytko, Nicolaus Andratschke, Matthias Guckenberger Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland Purpose/Objective: Peer-review is an established quality assurance process in radiation oncology. The PRIORITY trial showed that a two-step process (after contouring and after dosimetric planning) improves detection of delineation errors but increases workload. To optimize efficiency without compromising safety, we aimed to identify cases that could safely bypass one or both peer-review steps. Material/Methods: The single-center, prospective PRIORITY trial (figure 1) compared a single-step peer-review process (after complete treatment planning) with a two-step peer- review process (after contouring and after dosimetric planning). Between June and October 2023, 353 patients with 530 radiotherapy treatments were prospectively included (265 per cohort). Two logistic regression models were developed to identify predictors for (1) no contour and/or dose fractionation modification requests and (2) no dose distribution modification requests, with the goal of identifying subgroups, in which one or both peer-review steps could be safely omitted. Predictor variables included re-irradiation (re-RT) status, treatment technique (3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), stereotactic radiotherapy, online adaptive radiotherapy), and meeting all organ-at-risk (OAR) dose constraints.
Conclusion: The establishment of the I-RTQA-WG has fostered collaboration, facilitated knowledge sharing, and supported the practical implementation of techniques required to obtain RTQA credentialing from the UK RTTQA Group.This model has strengthened trial readiness, fostered collaboration between centres, with the aim of reducing trial start up time for all sites and laid the foundation for future national collaborations. Ongoing work will include a collective audit of practice changes and quality improvements associated with opening the FAST-Forward Boost trial. Keywords: National RTQA Group
Figure 1.The two different cohorts in the prospective PRIORITY trial. Results: The two-step peer-review resulted in significantly increased numbers of contour and/or dose fractionation modifications (42/265, 17%) compared to the single-step peer-review (12/265, 5%; p < 0.001). Dose distribution modifications were infrequent and not significantly different between cohorts (1.5% vs. 1.1%, p=0.85). There were less contour/dose fractionation modifications as well as dose distribution modifications for 3DCRT, stereotactic treatments and non-re-RT treatments compared to other treatment
Digital Poster 1318
Optimizing Peer-Review in Radiation Oncology — Secondary Analysis of the Prospective PRIORITY Trial
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