Radiologists can play key role in radiation therapy planning, but reimbursement an impediment
Radiologists can play a key role in radiation therapy planning, though a lack of reimbursement may hinder these efforts, according to new research.
Peer review of these plans is critical to ensuring safe and high-quality cancer care, experts write in the JAMA Network Open. Image interpretation can be one major source of variability, with some radiation oncologists forced to read MR, CT and other exams during the RT planning process.
“While radiation oncologists are classically trained to interpret clinical scenarios…residents are provided with limited formal training in diagnostic image interpretation,” RO expert Ryan T. Hughes, MD, with Wake Forest University in Winston Salem, North Carolina, and co-authors advised. “As a result, significant variability in tumor delineation may exist between radiation oncologists and radiologists.”
To address this challenge, some hospitals have embedded radiologists into peer review conferences to provide a more detailed review of proposed treatment. Hughes and colleagues hoped to better understand this trend, systematically reviewing research related to radiologist-RO peer review.
The final tally included nearly 40,000 radiotherapy cases detailed in 31 different analyses. Higher rates of RT plan changes were seen with radiologist involvement (49%) versus cases without such peer review (25%). Radiologist participation also was associated with increases in major (47% vs. 10%) but not minor changes (15% vs. 14%).
“The benefits of radiology involvement in [peer review] of radiation oncologist-delineated contours must outweigh the potential barriers to routine implementation of this practice,” the authors cautioned. “The main potential benefit apparent from our meta-analysis is clinically meaningful improvements to the RT plan. However, barriers include time limitations, technological considerations, and lack of a current reimbursement model for this additional effort.”
Logistics is one area of concern, the authors noted, and solutions would likely vary by institution. Possible collaboration models might include in-person, virtual or telephone conversations, along with separate reviews of related images handled by both radiologists and radiation oncologists via the electronic health record. Novel methods to facilitate interdisciplinary review are likely needed, Hughes et al. added. However, there currently is no pathway to gain reimbursement for this work, with radiologists likely spending upward of 60 minutes per case, depending on complexity, impacting diagnostic productivity. But radiologist involvement could spell cost savings by preventing the potential failure of RT treatment.
“Prospective evidence of improved oncologic outcomes would be necessary to support the development of professional reimbursement mechanisms or procedure codes like those used in other RT planning procedures, such as radiosurgery,” the authors added. “Our findings also provide practical insight into the efficient and cost-effective use of multidisciplinary resources for collaborative [peer review] of RT targets.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.