Enhancing the role of case-oriented peer review to improve quality and safety in radiation oncology: Executive summary.

This report is part of a series of white papers commissioned for the American Society for Radiation Oncology (ASTRO) Board of Directors as part of ASTRO's Target Safely Campaign, focusing on the role of peer review as an important component of a broad safety/quality assurance (QA) program. Peer review is one of the most effective means for assuring the quality of qualitative, and potentially controversial, patient-specific decisions in radiation oncology. This report summarizes many of the areas throughout radiation therapy that may benefit from the application of peer review. Each radiation oncology facility should evaluate the issues raised and develop improved ways to apply the concept of peer review to its individual process and workflow. This might consist of a daily multidisciplinary (eg, physicians, dosimetrists, physicists, therapists) meeting to review patients being considered for, or undergoing planning for, radiation therapy (eg, intention to treat and target delineation), as well as meetings to review patients already under treatment (eg, adequacy of image guidance). This report is intended to clarify and broaden the understanding of radiation oncology professionals regarding the meaning, roles, benefits, and targets for peer review as a routine quality assurance tool. It is hoped that this work will be a catalyst for further investigation, development, and study of the efficacy of peer review techniques and how these efforts can help improve the safety and quality of our treatments.

Subspecialization in radiology and radiation oncology.

Practicing radiologists, radiation oncologists, and trainees were surveyed regarding the current state of subspecialization in practice and in training curricula. The authors present the results of these surveys, establish trends compared with previous survey data, and compare the plans of trainees with current postgraduate practice. Subspecialization is increasing in both radiology and radiation oncology. There remain substantial numbers of practitioners who perform work they deem "general" in nature. The authors also present a method to more accurately measure subspecialization and workload.

ACR white paper: the value added that radiologists provide to the health care enterprise.

Radiologists represent arguably one of medicine's least heralded but most important specialties. Although they carry sterling credentials as imaging and radiation safety experts, radiologists have lacked widespread public recognition. As public and private stakeholders cast an even more intense spotlight on imaging, the vital role of radiologists must be better understood. During the January 2008 ACR Forum on Future Practice Models for Radiology, participants and ACR leaders discussed the value added that radiologists bring to the health care enterprise and recommended that the ACR further study that topic. The ACR, dedicated to providing quality patient care since its inception in 1924, convened the Task Force on Value Added to address these issues. The task force determined the component stakeholders in the health care enterprise to whom value is added, defined the nature of the value for each constituent component, described the process of adding that value, and anticipated future trends that may affect the value proposition. Recommendations to the ACR for future action are offered.