Challenge accepted.

Top Line: What factors influence the decision to accept or reject daily IGRT images?

The Study: This study analyzed accept or reject decisions for 51,797 IGRT images performed from 2016 to 2018. These decisions were made by 10 physicians covering 4 different sites in the MD Anderson system. CBCT (65%) was more common than kV or portal imaging (35%). Most images were reviewed by the treating physician (63.3%) during business hours (84%), and most physicians reviewed 1-20 images daily (63.2%, median 17 images). Among the >50,000 images, just 1.7% were rejected. Across physicians, the rejection rate ranged from 0.4% to 4.2% with “low rejectors” rejecting 0.3-1.2% of images and “high rejectors” rejecting 1.5-4.2% of images. Multivariable analysis found that the factors most strongly associated with image rejection were: review by a high rejector (OR 3.28), anatomic site of the skin, breast, or head and neck, and CBCT image (versus kV/portal, OR 1.67). Factors notably not associated with rejection were after hours review and treating versus non-treatment physician review. A qualitative study of comments or instructions following rejection would be particularly informative to better understand why physicians reject particular images and what improvements could be made in the quality of IGRT review.

TBL: While the rate of IGRT image rejection is low, there is considerable (as much as 10-fold) variation among physicians. | Rooney, JCO Oncol Pract 2022