Including radiologists in radiotherapy prep bolsters quality of care

Getting radiologists more involved with radiotherapy planning may help to boost the quality of care for lung cancer patients, according to a new analysis published in Academic Radiology.

Many radiation oncologists are not formerly trained in imaging interpretation. And radiologists’ collaborative participation in care planning can help to catch errors and ensure that tumors have been properly removed. One 2014 analysis found that radiologist guidance resulted in practice changes for about 45% of radiotherapy cases.

Experts at Wake Forest School of Medicine sought to adopt this practice change, conducting a prospective clinical treatment trial involving 37 patients and three thoracic radiologists. They found early success, with collaboration between departments resulting in notable gains.

“This study demonstrates that radiologist contour review during [radiotherapy] planning for [locally advanced lung cancer] is feasible, can be completed without treatment delays and may lead to meaningful plan changes,” Michael K. Farris, MD, with the Department of Radiation Oncology at the Wake Forest School of Medicine, in Winston-Salem, N.C., and co-authors wrote Feb. 7 [1]. “Additional studies are needed to determine whether optimized target delineation improves tumor control, reduces the need for expensive or morbid salvage treatments, reduces toxicity, and improves quality of life,” they cautioned.

Wake Forest enrolled patients across six centers for the prospective study, conducted between 2021 and 2022. Before finalizing their treatment plans, the six radiation oncologists shared CT slices (including overlaid outlines of preliminary irradiation targets) with the radiologist team. About 73% of cases received feedback within the study’s goal of four or fewer days. In 13 of the 35 plans reviewed (37%), radiologists determined that the target potentially did not include all sites suspicious of tumor involvement. Rads recommended changes for over- or under-coverage in 46% of radiotherapy plans, which radiation oncologists implemented in all instances. Farris et al. also found there were significant changes to irradiated volumes (gross tumor volume, −1.9 to +96.1%; planning target volume, −37.5 to +116.5%).

While the results are encouraging, the study’s authors warned that their sample size was small, and reimbursement does not yet support such a practice change.

“Radiologist review of [radiotherapy] plans is not a billable service,” they wrote. “As such, radiologists choosing to participate may lack institutional and department support.”