Jessica Zhang
Conrad Bayley
Marcus Vaska4
Sangjune Laurence Lee- 1Department of Medicine, University of Alberta, Edmonton, AB, Canada
- 2Department of Oncology, University of Calgary, Calgary, AB, Canada
- 3Department of Radiation Oncology, Arthur J.E. Child Comprehensive Cancer Center, Calgary, AB, Canada
- 4Library Services, Acute Care Alberta, Edmonton, AB, Canada
Purpose: In radiation oncology (RO), peer review (PR) rounds are essential for ensuring quality care, enhancing team communication, and identifying areas for improvement in radiotherapy (RT) plans. However, time constraints, lengthy discussions, and imbalanced team contributions often hinder effective PR. This scoping review examined novel tools and processes to enhance PR efficiency and experience in modern academic centers.
Materials and methods: We queried six databases [MEDLINE (Ovid), EMBASE, PubMed, Cochrane Library, CINAHL, and MEDLINE (Ebsco)] and the gray literature, yielding 8,955 citations. Studies were excluded if they (1) were focused on comparisons involving paper-based rounds, (2) lacked clear relevance to PR processes in RT, or (3) did not explicitly address efficiency within PR activities.
Results: Twelve studies focusing on PR structure and efficiency-related processes were included. Of the identified, 11/12 explored various structural formats to improve facilitation, 5/12 discussed automated tools, and 2/12 evaluated checklists. Only half of studies reported a PR-associated time burden, with 2/12 reporting positive post-implementation changes. The remaining studies did not measure comparative times.
Conclusions: This scoping review reveals the lack of work on innovative approaches to optimize PR rounds in RO, despite the commonly reported participation barrier of high time commitment. Our findings highlight the importance of integrating automation in order to streamline facilitation methods and tools such as checklists to reduce inefficiency, given PR’s essential role in patient safety and clinical learning. Future research should prioritize the development and evaluation of time-saving strategies and tools for PR in RO workflow to optimize its sustainability and impact.
1 Introduction
In radiation oncology (RO), peer review (PR) rounds—also referred to colloquially as quality assurance (QA) rounds—are conducted routinely to ensure that standards of care are met, to foster communication within the multidisciplinary team, and to identify potential deficiencies or areas for improvement (1–4). PR has long been a pillar of Canadian radiotherapy (RT) standards, promoting the delivery of safe and high-quality care (1, 5). Canadian initiatives, such as Ontario’s Radiation Treatment Program Implementation Plan for 2019–2023, identified PR as a priority for enhancing the quality and safety of RT across cancer centers. They championed the evaluation of “best practices” in PR, the incorporation of novel strategies, and utility of artificial intelligence (AI) (6). Despite its recognized importance, several barriers to effective QA rounds have been reported, including scheduling constraints, lengthy discussion periods exceeding allotted time, and inconsistent participation from members of the multidisciplinary team (4, 7, 8).
The impact of PR on treatment planning and clinical outcomes has been an ongoing area of investigation. A 2013 survey conducted by the American Society for Radiation Oncology (ASTRO) found that over 90% of respondents had made changes to treatment plans as a result of PR at some point in their career. However, the estimated overall impact on case revisions at that time was 4%–7% of those brought forth to rounds (9). More recent evidence from a systematic review and meta-analysis from 2025 presents a contrasting view, which reported that PR influenced treatment plan changes in over 25% of cases (10). In specialized contexts, namely, the use of magnetic resonance linear accelerators (MR-Linacs), PR can lead to modifications to 36.4% of treatment plans (11). For delineation of planning target volumes (PTVs) and organs at risk (OARs), recommended changes were observed in approximately 10% of 7,645 reviewed cases (12).
From the perspective of radiation oncologists, multiple surveys have assessed experiences with PR. Canadian radiation oncologists generally recognize the value of PR in improving treatment planning; however, time constraints and lack of protected time for participation are consistently identified as major barriers (7, 8). Notably, implementation of protected time policies has been associated with improved physician attendance (13). These findings suggest that strategies to reduce time burden and improve workflow efficiency could enhance engagement and the overall effectiveness of PR. The present study seeks to answer the question: for the RO workflow within academic RT centers, what effect do novel tools and strategies have on the PR process in terms of decreased time burden, ability to correct treatment plans, and general implementation as compared to the current standard QA process?
2 Methods
This review follows the 2018 PRISMA extension for scoping reviews (PRISMA-ScR) protocol (14). In collaboration with a health sciences librarian (M.V.), a comprehensive search strategy was developed to identify studies addressing efficiency in PR rounds within the context of RT (see the Supplementary Materials). In August 2024, systematic searches were conducted across six electronic databases: MEDLINE (Ovid), EMBASE, PubMed, Cochrane Library, CINAHL and MEDLINE (Ebsco). Gray literature sources were also included. The search yielded a total of 8,955 citations. Studies were excluded if they (1) focused on comparisons involving paper-based rounds, (2) lacked clear relevance to PR processes in RT, or (3) did not explicitly address efficiency within PR activities. Title and abstract screening, followed by full-text review, were independently performed by two reviewers (C.B. and J.Z.) using Covidence (Veritas Health Innovation, Melbourne, Australia, 2024). Discrepancies were resolved through consensus. Data extraction was conducted using a standardized template to ensure consistency across included studies (see the Supplementary Materials).
A reflexive thematic analysis aligned with Braun and Clarke’s framework was performed to synthesize findings (15). PR approaches were thematically grouped into three domains: automation, facilitation, and the use of checklists. For the purpose of this review, automation refers to the integration of tools or software that partially or fully automate elements of the PR process, while facilitation relates to organizational strategies and session structure. Checklists represent a standardization tool aimed at improving consistency and completeness of plan evaluation.
3 Results
A total of 395 studies were independently screened by title and abstract, with 65 selected for full-text review (Figure 1). Of these, 12 studies met inclusion criteria, focusing specifically on the structure and efficiency of PR processes in RT.
Figure 1. PRISMA 2020 flow diagram for radiation oncology peer review scoping review*. *Multiple overlapping studies identified from systematic search and citation searching. Source: Page MJ, et al. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
Among the included studies, 11 out of 12 (92%) examined modifications to PR structure aimed at improving facilitation. Five studies (40%) evaluated the use of automated tools, while two (17%) discussed structured checklists. These themes are summarized in Table 1. Only six studies (50%) reported data on time burden associated with PR processes, and of these, only two studies described measurable improvements in efficiency following implementation of new interventions, discussed below. The remaining studies did not report comparative time metrics. The study aims, interventions, methods, results, and limitations are summarized in Table 2.
Table 1. Summary of thematic analysis.
Table 2. Overview of included studies on peer review efficiency in radiation oncology.
3.1 Automation
Over the past decade, the application of automation within PR has gained traction, with an emphasis on standardizing inherently qualitative and subjective processes (16). There has been more recent exploration of the potential role of AI in consolidating PR activities. Talcott et al. (17), for instance, generally described the use of AI to generate “score cards” and support decision-making in QA rounds (17). However, concerns related to automation bias, user complacency, and the risk of systematic errors remain notable. Several innovations have been described, including automated tools designed to assess case complexity, generate PR case lists with relevant clinical information, and produce dose volume histogram (DVH) analyses (18–20). Barry et al. (18) developed a simple automated scoring system based on complexity and planning for breast RT that was easily integrated into PR (18). Ali et al. (19) implemented a similar standardized scoring system that was able to integrate feedback directly into physician feedback (19). Albert et al. (20) employed a color-based scorecard if dose constraints were met or not, signified by green and red, respectively. They reported a mean presentation time of 8 min per case (20). Furthermore, Kim et al. (16) reported the ability of novel cloud-based platform to rapidly evaluate target volume delineation in head and neck RT against 2018 international standards. They reported an undercoverage of the cavernous sinus but otherwise had high compliance rates (16). The studies on automation mentioned did not otherwise elaborate on improvements to efficiency. These approaches demonstrate the growing interest in leveraging automation to streamline PR and improve standardization.
3.2 Facilitation
Modifications to PR round structure have also been explored as a means of enhancing efficiency. Decreasing the number of participants needed to successfully run a PR session is one possible solution. Ali et al. (19) found that when they implemented a New Chart Review (NCR) structure consisting of six 1-h site-specific sessions per week, it allowed improved review of palliative plans and reduced absolute participant number at each round when compared to Standard Chart Review (SCR), consisting of two 90-min weekly sessions encompassing all treatment sites (19).
An emerging model, “on-demand” PR, was designed to prioritize cases requiring urgent review while avoiding unnecessary treatment delays. Fong et al. (21) conducted a pilot project where four head and neck radiation oncologists were able to voluntarily submit cases for PR “on-demand”. They then compared the time taken for this process to their traditional weekly review approach. The authors observed a statistically significant reduction in time burden (p < 0.0001) with this model, though there were challenges related to voluntary participation and uneven contribution among radiation oncologists. Furthermore, they noted that there is no current agreement on priority classification for cases. The authors recommended supplementing on-demand reviews with periodic consensus meetings to maintain educational opportunities and ensure an equitable workload distribution (21). A subsequent study also reported favorable perceptions of on-demand PR in improving timeliness (22).
Group consensus-based PR remains a widely adopted approach for developing tools or evaluating aspects of PR (20, 23, 24, 35). A recent study by Gulstene et al. (25) suggests that independent PR may also be a viable alternative. They reported a reduction of approximately 50% in physician time burden (20.5 ± 6.0 vs. 9.7 ± 6.4 min) per plan compared to the traditional team approach. There were otherwise no significant differences in the rate of peer feedback, plan modifications, or the relationship between RO attendance and likelihood of plan changes between the two structures (29).
Prospective PR, conducted prior to treatment initiation, continues to be favored over retrospective models, as it enables early identification and correction of planning issues (26, 30). For example, Surucu et al. (27) integrated daily contouring and planning rounds (CPRs) alongside weekly chart rounds, facilitating the presentation of six to seven cases within a 45-min session. Importantly, the addition of daily CPR did not increase the overall time from simulation to treatment start, demonstrating the feasibility of prospective approaches without affecting efficiency (31).
3.3 Checklists
The use of medical checklists has been well-established in improving safety and standardization across clinical disciplines. National surveys within American RO have demonstrated strong interest in checklist adoption (32). Two studies described the development of consensus-based checklists for PR of RT treatment plans (28, 33). Swaminath et al. (2020) used a modified Delphi process involving a preliminary steering committee with subsequent pan-Canadian panel to generate a best practices guideline for curative lung RT. They reported high consensus that a second RO should carry out PR. Across locally advanced (LA) and SABR (stereotactic ablative body RT) cases, both shared elements of RT indications, gross tumor volume (GTV), clinical target volume (CTV), internal target volume (ITV), and dose/fractionation. LA also included normal lung dosimetry, while SABR had composite plan review deemed as essential (28). Boyd et al. (29) employed the nominal group technique (NGT) with a panel of 10 American academic radiation oncologists to create the first consensus external beam treatment plan checklist for generalized application. Their checklist included patient identification, imaging modality, treatment intent and modality, clinical trial participation, intended target volumes, OARs, presence of devices, beam energy, position, 3D dose distribution, and DVH (33). Between these two studies, their respective elements were overall similar. These tools were designed for comprehensive review and consistency in documentation and feedback.
4 Discussion
Benefits of PR include improving RT planning and delivery to maintain the highest standard of patient care. Undergoing the PR process also promotes the development of new RT protocols, providing an interdisciplinary learning environment to enhance team-based collaboration both within RT and across oncologic specialties (30).
Although efficiency remains a less explored area in the landscape of PR, other changes to the process have been associated with positive outcomes. For example, grading systems, whether manual or automated, have become more common. A 10-year prospective evaluation involving 20,069 cases implemented a grading system to categorize review outcomes: “A” (no changes), “B” (minor changes), and “C” (major changes). Over time, the proportion of “A” scores declined, while “B” scores increased, suggesting increased scrutiny and reduced incidence of major errors (“C” scores) in treatment planning (31). These findings imply improvements in PR processes and/or the adoption of more rigorous planning standards. In the last decade, there has also been a notable shift toward virtual PR platforms, aimed at enhancing accessibility regardless of institution size or geographic location, and improving equity in care delivery when PR is made accessible to all centers and patients (32). Of note, there remains continued support for prospective PR models, which allow for modifications to be implemented prior to treatment initiation (33, 34).
Among the literature reviewed, only one formal systematic review specifically addressed existing PR practices in RT. This review proposed recommendations for the structural components of PR rounds and advocated for the consistent documentation of outcomes using standardized criteria. Notably, none of the included studies reported time metrics or overall efficiency associated with their PR processes (35). The evaluation of efficacy in RO PR rounds is not a novel concern. As early as 1999, studies identified a lack of formal analysis linking PR structure to quality outcomes in RT QA (36). The present review reaffirms this gap: despite increasing awareness of the time-intensive nature of PR rounds, few studies have specifically addressed strategies to improve their efficiency. This deficiency is particularly notable given that time burden remains one of the most frequently cited barriers to consistent PR participation.
Inherent limitations of the PR process include its resource-intensive nature alongside variations in frequency, case selection, and structure. Increasing automation in the PR process may help with standardization, at the risk of introducing automation bias, complacency, and systematic error if we begin to rely on tools for guidance. To prevent this over-reliance, it is important to maintain transparent documentation and a clear understanding of tools’ limitations, so that PR remains human-driven rather than machine-replaced. Critical thinking remains central to fulfilling the ultimate goal of patient safety by conducting PR rounds, and so automation should help improve efficiency and consistency without adversely impacting clinical judgment. Other unanswered questions remain such as the associated cost with PR processes and how much patients benefit from the changes made (13, 32). While there is robust support for the impact of PR on plan quality and error reduction, there is a lack of direct, prospective evidence establishing a relationship between PR rounds and improved patient-level outcomes including local control, survival, or toxicity. However, given the importance of safety checks and plan quality, it remains widely supported that PR is a critical process for optimizing patient care across multiple specialties. In a 2017 systematic review, Brunskill et al. found that PR led to changes in clinical planning for 11% of included cases, a similar rate to adjacent specialties such as pathology and radiology (37).
5 Limitations
This scoping review ultimately identified a small number of relevant studies, which may reflect limitations in the search strategy to have picked up all targeted interventions. The inclusion criteria were set to English language only, which may have also limited the search results. For quality analysis of studies, we commented on limitations as reported by the authors but did not conduct formal independent analyses.
6 Future directions
Despite ongoing variability in PR implementation across academic centers, a general consensus exists regarding its timing and core components. However, critical questions remain, particularly concerning cost-effectiveness and the tangible clinical benefits for patients (13, 32). Emerging areas of exploration include determining the optimal number of physicians required for team-based PR and assessing the utility of AI-driven tools to detect contouring or planning errors (25, 38–40). With advancing capabilities in image recognition and automated QA, AI-based platforms may offer valuable support to enhance accuracy and consistency (16). As a notable example, Talcott et al. (41) introduced deliberate errors into PR rounds and observed a detection rate of 55%, with earlier-presented cases demonstrating higher detection likelihood—highlighting the potential benefits of shorter or more focused review sessions (41). The consistent reporting and evaluation of time spent in PR, as advocated by Albert et al. (20), could also provide valuable benchmarks for institutional improvement (20).
As Hendee and Herman (2011) astutely put, “A single error that harms a radiation therapy patient is one error too many” (42). While technological advancements continue to evolve, the role of integrated human oversight remains indispensable. Moving forward, the development of tools and workflows must be grounded in the shared objective of delivering safe, effective, and patient-centered care. PR processes should not only be rigorous but also be feasible—balancing efficacy with efficiency to best support both clinical teams and the patients they serve.
7 Conclusion
This scoping review highlights the need to optimize the efficiency and structure of PR in RT through diverse strategies such as automation, session formatting, and standardized tools including checklists. While more novel approaches, such as on-demand review and AI-supported tools, demonstrate promising outcomes, evidence remains limited with respect to direct comparisons of time efficiency and ultimate clinical impact. As PR remains integral to clinical decision-making, patient safety, and professional development in RO, further innovation is essential to ensure its sustainability and value in modern practice. More studies that aim to quantify time burden, conduct objective comparisons of software solutions, and evaluate clinical outcomes from changes made during the PR process are warranted to evaluate the long-term effectiveness, feasibility, and scalability of these interventions across varied clinical settings.
Data availability statement
The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.
Author contributions
JZ: Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. CB: Conceptualization, Investigation, Supervision, Writing – review & editing. MV: Resources, Supervision, Writing – review & editing. SL: Conceptualization, Supervision, Writing – review & editing.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that generative AI was not used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fonc.2026.1686796/full#supplementary-material
References
1. Giuliani M and Gospodarowicz M. Radiation oncology in Canada. Jpn J Clin Oncol. (2018) 48:22–5. doi: 10.1093/jjco/hyx148
2. Chang D, Moore A, van Dyk S, and Khaw P. Why quality assurance is necessary in gynecologic radiation oncology. Int J Gynecol Cancer. (2022) 32:402–6. doi: 10.1136/ijgc-2021-002534
3. Lee G and Koch CA. Interprofessional collaboration in radiation therapy. J Med Imaging Radiat Sci. (2020) 51:S112–3. doi: 10.1016/j.jmir.2020.08.002
4. Brundage M, Foxcroft S, McGowan T, Gutierrez E, Sharpe M, and Warde P. A survey of radiation treatment planning peer-review activities in a provincial radiation oncology programme: current practice and future directions. BMJ Open. (2013) 3:e003241. doi: 10.1136/bmjopen-2013-003241
5. Mackenzie J, Graham G, and Olivotto IA. Peer review of radiotherapy planning: quantifying outcomes and a proposal for prospective data collection. Clin Oncol (R Coll Radiol). (2016) 28:e192–8. doi: 10.1016/j.clon.2016.08.012
6. Cancer Care Ontario. Radiation treatment program implementation plan 2019–2023 (2019). Available online at: https://www.cancercareontario.ca/en/cancer-care-ontario/programs/clinical-services/radiation-treatment/implementation-plan-2019-2023 (Accessed June 26, 2025).
7. Caissie A, Rouette J, Jugpal P, Davis CA, Hollenhorst H, O’Donnell J, et al. A pan-Canadian survey of peer review practices in radiation oncology. Pract Radiat Oncol. (2016) 6:342–51. doi: 10.1016/j.prro.2016.01.014
8. Hamilton SN, Hasan H, Parsons C, Tyldesley S, Howard AF, Bobinski MA, et al. Canadian radiation oncologists’ opinions regarding peer review: A national survey. Pract Radiat Oncol. (2015) 5:120–6. doi: 10.1016/j.prro.2014.06.002
9. Hoopes DJ, Johnstone PA, Chapin PS, Schubert Kabban CM, Lee WR, Chen AB, et al. Practice patterns for peer review in radiation oncology. Pract Radiat Oncol. (2015) 5:32–8. doi: 10.1016/j.prro.2014.04.004
10. Jomy J, Lu R, Sharma R, Lin KX, Chen DC, Winter J, et al. A systematic review and meta-analysis on the impact of institutional peer review in radiation oncology. Radiother Oncol. (2025) 202:110622. doi: 10.1016/j.radonc.2024.110622
11. Sin Y, Batumalai V, de Leon J, Leong E, Rahim K, Kasraei F, et al. Does a peer review group consensus process for MR-Linac patients affect clinical care? Evaluation of impact and feasibility. Clin Transl Radiat Oncol. (2024) 48:100816. doi: 10.1016/j.ctro.2024.100816
12. Riegel AC, Vaccarelli M, Cox BW, Chou H, Cao Y, and Potters L. Impact of multi-institutional prospective peer review on target and organ-at-risk delineation in radiation therapy. Pract Radiat Oncol. (2019) 9:e228–35. doi: 10.1016/j.prro.2018.10.016
13. Lawrence YR, Whiton MA, Symon Z, Wuthrick EJ, Doyle L, Harrison AS, et al. Quality assurance peer review chart rounds in 2011: a survey of academic institutions in the United States. Int J Radiat Oncol Biol Phys. (2012) 84:590–5. doi: 10.1016/j.ijrobp.2012.01.029
14. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. (2018) 169:467–73. doi: 10.7326/M18-0850
15. Braun V and Clarke V. Using thematic analysis in psychology. Qual Res Psychol. (2006) 3:77–101. doi: 10.1191/1478088706qp063oa
16. Kim JW, Marsilla J, Kazmierski M, Tkachuk D, Huang SH, Xu W, et al. Effect of radiation therapy quality assurance on nasopharyngeal carcinoma: usage of a novel, web-based quality assurance application. Pract Radiat Oncol. (2023) 13:e354–64. doi: 10.1016/j.prro.2023.03.003
17. Talcott W, Covington E, Bazan J, and Wright JL. The future of safety and quality in radiation oncology. Semin Radiat Oncol. (2024) 34:433–40. doi: 10.1016/j.semradonc.2024.07.008
18. Barry AS, Sole CV, McIntosh C, Purdie TG, and Koch CA. Applying a real time pretreatment review of radiation oncology breast cancer rounds: Automated quality assurance results. Int J Radiat Oncol Biol Phys. (2015) 93:E586. doi: 10.1016/j.ijrobp.2015.07.2045
19. Ali N, Schreibmann E, Kayode O, Patel A, Patel P, Qian D, et al. Implementation of a novel chart rounds application to facilitate peer review in a virtual academic environment. Adv Radiat Oncol. (2024) 9:101406. doi: 10.1016/j.adro.2023.101406
20. Albert AA, Duggar WN, Bhandari RP, Vengaloor Thomas T, Packianathan S, Allbright RM, et al. Analysis of a real time group consensus peer review process in radiation oncology: an evaluation of effectiveness and feasibility. Radiat Oncol. (2018) 13:239. doi: 10.1186/s13014-018-1190-z
21. Fong C, Sanghera P, Good J, Nightingale P, and Hartley A. Implementing head and neck contouring peer review without pathway delay: the on-demand approach. Clin Oncol (R Coll Radiol). (2017) 29:841–7. doi: 10.1016/j.clon.2017.09.005
22. Bhattacharyya T, Chakraborty S, Achari RB, Mallick I, Arunsingh M, Shenoy S, et al. Enhancing quality assurance in radiotherapy for gynaecological cancers: implementation of an on-demand peer review process. Br J Radiol. (2024) 97:680–93. doi: 10.1093/bjr/tqae019
23. Vijayakumar S, Duggar WN, Packianathan S, Morris B, and Yang CC. Chasing zero harm in radiation oncology: using pre-treatment peer review. Front Oncol. (2019) 9:302. doi: 10.3389/fonc.2019.00302
24. Swaminath A, Yaremko B, Khan L, Simniceanu C, Hart M, O’Donnell J, et al. Development of best practices of peer review for lung radiation therapy. JCO Oncol Pract. (2020) 16:e1181–91. doi: 10.1200/OP.20.00066
25. Gulstene S, Mutsaers A, O’Neil M, Warner A, and Rodrigues G. evaluating peer review of palliative radiation plans at a Canadian tertiary care cancer center. Cureus. (2024) 16:e57839. doi: 10.7759/cureus.57839
26. Ludmir EB, Hoffman KE, Jhingran A, Kouzy R, Ip MP, Sturdevant L, et al. Implementation and efficacy of a large-scale radiation oncology case-based peer-review quality program across a multinational cancer network. Pract Radiat Oncol. (2024) 14:e173–9. doi: 10.1016/j.prro.2023.12.007
27. Surucu M, Bajaj A, Roeske JC, Block AM, Price J, Small W Jr, et al. The impact of transitioning to prospective contouring and planning rounds as peer review. Adv Radiat Oncol. (2019) 4:532–40. doi: 10.1016/j.adro.2019.03.004
28. Feng J, Erickson BA, Currey AD, Shukla ME, Desai N, Bergom C, et al. Attitudes and beliefs towards medical checklists in radiation oncology. Int J Radiat Oncol Biol Phys. (2021) 111:S112–3. doi: 10.1016/j.ijrobp.2021.07.259
29. Boyd GH, Dilling TJ, Gibbs IC, Golden DW, Mak RH, Olivier K, et al. Development of a consensus checklist for systematic radiation treatment plan review. Int J Radiat Oncol Biol Phys. (2024) 120:e515. doi: 10.1016/j.ijrobp.2024.07.1144
30. Brundage MD, Hart M, O’Donnell J, Reddeman L, Gutierrez E, Foxcroft S, et al. I sleep better at night:” how peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs. Pract Radiat Oncol. (2016) 7:281–8. doi: 10.1016/j.prro.2016.11.007
31. Tchelebi LT, Kapur A, Chou H, and Potters L. A decade of prospective peer review: impact on safety culture and lessons learned in a multicenter radiation medicine department. Pract Radiat Oncol. (2023) 13:e325–31. doi: 10.1016/j.prro.2023.01.003
32. Chen RC. Commentary: toward safe and high quality care through peer review in radiation oncology: need for more evidence. Pract Radiat Oncol. (2014) 4:285–7. doi: 10.1016/j.prro.2013.12.006
33. Gogineni E, Schaefer D, Ewing A, Andraos T, DiCostanzo D, Weldon M, et al. Systematic implementation of effective quality assurance processes for the assessment of radiation target volumes in head and neck cancer. Pract Radiat Oncol. (2024) 14:e205–13. doi: 10.1016/j.prro.2023.12.012
34. Duggar WN, Bhandari R, Yang CC, and Vijayakumar S. Group consensus peer review in radiation oncology: commitment to quality. Radiat Oncol. (2018) 13:55. doi: 10.1186/s13014-018-1006-1
35. Lewis PJ, Court LE, Lievens Y, and Aggarwal A. Structure and processes of existing practice in radiotherapy peer review: a systematic review of the literature. Clin Oncol (R Coll Radiol). (2021) 33:248–60. doi: 10.1016/j.clon.2020.10.017
36. Fogarty GB, Hornby C, Ferguson HM, and Peters LJ. Quality assurance in a Radiation Oncology Unit: the chart round experience. Australas Radiol. (2001) 45:189–94. doi: 10.1046/j.1440-1673.2001.00901.x
37. Brunskill K, Nguyen TK, Boldt RG, Louie AV, Warner A, Marks LB, et al. Does peer review of radiation plans affect clinical care? A systematic review of the literature. Int J Radiat Oncol Biol Phys. (2017) . 97:27–34. doi: 10.1016/j.ijrobp.2016.09.015
38. Li Q, Wright J, Hales R, Voong R, and McNutt T. A digital physician peer to automatically detect erroneous prescriptions in radiotherapy. NPJ Digit Med. (2022) 5:158. doi: 10.1038/s41746-022-00703-9
39. Kalendralis P, Luk SMH, Canters R, Eyssen D, Vaniqui A, Wolfs C, et al. Automatic quality assurance of radiotherapy treatment plans using Bayesian networks: A multi-institutional study. Front Oncol. (2023) 13:1099994. doi: 10.3389/fonc.2023.1099994
40. Altman MB, Kavanaugh JA, Wooten HO, Green OL, DeWees TA, Gay H, et al. A framework for automated contour quality assurance in radiation therapy including adaptive techniques. Phys Med Biol. (2015) 60:5199–209. doi: 10.1088/0031-9155/60/13/5199
41. Talcott WJ, Lincoln H, Kelly JR, Tressel L, Wilson LD, Decker RH, et al. A blinded, prospective study of error detection during physician chart rounds in radiation oncology. Pract Radiat Oncol. (2020) 10:312–20. doi: 10.1016/j.prro.2020.05.012
Keywords: chart review, efficiency, health care, peer review, radiation oncology
Citation: Zhang J, Bayley C, Vaska M and Lee SL (2026) Optimizing peer review rounds in radiation oncology: a scoping review. Front. Oncol. 16:1686796. doi: 10.3389/fonc.2026.1686796
Received: 01 October 2025; Accepted: 20 January 2026; Revised: 20 December 2025;
Published: 06 February 2026.
Edited by:
Timothy James Kinsella, Brown University, United StatesReviewed by:
William Chen, Northwell Health, United StatesMatthew Knox, St. George Hospital, Australia
Copyright © 2026 Zhang, Bayley, Vaska and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sangjune Laurence Lee, c2FuZ2p1bmUubGVlQHVjYWxnYXJ5LmNh