The Utility of Video-Based Pre-Treatment Peer Review in the COVID Era

PURPOSE/OBJECTIVE(S): Pre-treatment peer review has been suggested to be useful within Radiation Oncology. With the COVID-19 pandemic, our previously-applied face-to-face format was replaced with a video-based format. We herein quantify the usefulness of daily video-based peer review within a busy radiation oncology practice. MATERIALS/METHODS: We have been using an internet-based format for our daily peer review since mid-March 2020. All cases in the department are reviewed prior to planning and a subset, typically stereotactic body radiotherapy (SBRT) cases, are reviewed twice: once for contours and once for the planned dose. A meeting participant collected data regarding attendance, case type, and recommendations made in the meetings. An anonymous survey was sent to all participants to assess their opinion of this daily meeting. The number and type of recommendations resulting from the video-based peer review were compared to the results of a similar review conducted in the pre-COVID (face-to-face) era using a two-tailed Fisher's exact test. RESULTS: From September 11, 2020 – December 23, 2020, data was gathered from 62 peer-review sessions. The mean number of attendees each day was 43 (range 32-60), including 9 MD faculty (range 4-12) and 7 MD residents (range 5-8). The average number of cases reviewed each day was 9 (range 3-17). In total, 533 cases were reviewed; 74% had no recommendations, 8% had mild, 15% had moderate, and 3% had major recommendations leading to significant changes in treatment planning. Among cases reviewed during the pre-COVID era 73% had none, 10% had mild, 10% had moderate, and 7% had major recommendations. The rate of major recommendations during the current video-format era is significantly decreased from before (3% vs 7%, P < 0.001). Twenty-nine participants responded to the survey. For the video-based peer review session, 97% reported that it adds value to the department, 83% reported that it provides an excellent learning environment, and 93% reported that it allows for a collegial debate/conversation. CONCLUSION: Video-based peer review can be effective; 18% of case reviews resulted in moderate/major recommendations. While comparisons across time are imperfect, this is almost identical to the 17% observed in the pre-COVID (face-to-face) era, which is reassuring. However, the rate of major recommendations from the current video-format era were lower than in the pre-COVID (face-to-face) era, suggesting that the robustness of daily peer review may be reduced with video. Nevertheless, the majority of participants responding to the survey (83-97%) still find the overall process useful.