IMRT planning quality under a single full-time radiation oncologist supported by structured remote peer review and planning assistance versus the two-oncologist standard: the REMOTE-IMRT prospective, pair-matched, multi-institutional trial.

PURPOSE: To determine whether intensity-modulated radiation therapy (IMRT) plan quality under a proposed facility standard of one full-time radiation oncologist supported by structured remote or part-time peer review and mandatory planning assistance is comparable to Japan's current standard requiring two full-time radiation oncologists.

MATERIALS AND

METHODS

In this multicenter, pair-matched, prospective trial, 41 institutional pairs were enrolled and 36 completed per protocol. Within each pair, one institution had two full-time radiation oncologists (Group A) and the other had one full-time radiation oncologist (Group B), with mandated remote or part-time peer review and planning-assistant involvement at the single-oncologist site. Common cases (prostate cancer; nasopharyngeal carcinoma [NPC] with whole-neck [WNI] or local boost [LBI] irradiation) and consensus reference contours were provided. Primary endpoints were target delineation accuracy versus the reference contour (dice similarity coefficient, DSC) and plan quality (plan quality metric, PQM; 0-100).

RESULTS

Differences in DSC (Group B - A) were 0.00 (95% CI - 0.02 to 0.02) for prostate cancer, - 0.02 (- 0.06 to 0.02) for NPC-WNI, and - 0.04 (- 0.09 to 0.02) for NPC-LBI. PQM differences were 2.01 (- 2.05 to 6.07), - 3.51 (- 8.65 to 1.62), and - 2.52 (- 6.52 to 1.49), respectively. All differences fell within the pre-specified comparability margins, with no significant between-group differences.

CONCLUSION

Under these benchmark study conditions, target delineation accuracy and plan quality under a single full-time radiation oncologist supported by structured remote/part-time peer review and mandatory planning assistance were comparable to Japan's two-oncologist standard, supporting the feasibility of this structured model for widening IMRT access.