ACRO’s Maintenance of Certification (MOC) Support Project
Evaluate initial charts
Measure performance vs. benchmark criteria
Enact improvement plan
Re-measure performance
Grow via analysis
A critical component of the MOC process in radiation oncology is Practice Quality Improvement (PQI). Focused self-assessment of current practice is one method by which the radiation oncologist may gauge current strengths and weaknesses, ultimately realizing the potential for professional growth. As a benefit for its physician members, ACRO has developed MOC Chart Review Templates for the treatment of both breast and prostate cancers, two of the most common malignancies treated in radiation oncology practices throughout the United States. ACRO physician members may utilize these templates to assist in fulfillment of the PQI component of the MOC as currently required by the American Board of Radiology (ABR). The radiation oncologist may complete the ACRO MOC project in the following steps:
1. Select 10 charts of patients who have completed treatment with curative intent for a diagnosis of either breast cancer or prostate cancer.
2. Review each chart for specific benchmark criteria noted in the attached appropriate (Breast or Prostate) Chart Review Templates, scoring personal performance based on the 10-point scale provided. One document should be completed for each selected patient chart.
3. Following analysis of 10 patient charts, physician generates written improvement plan to address weaknesses noted.
4. Second set of 10 patient charts with same diagnosis is then selected to re-measure performance. These charts must be for patients who have initiated treatment at any time after radiation oncologist’s completion of the individual improvement plan, but not to exceed 24 months thereafter. The same process described in steps 2 and 3 above is utilized to re-measure performance and generate final project summary.
5. Physician member should maintain documentation of all work (10 initial chart review forms, improvement plan, second set of 10 chart review forms, and final project summary) for ABR auditing purposes.
ACRO’s MOC Chart Review Template: BREAST Cancer
For each of the 10 criteria listed, score 1 only if ALL listed critical components have been fulfilled; score 0 if ANY component is incomplete.
CONSULTATION Score
1. Pertinent History: local or systemic symptoms (if present); nutritional and pain ___ assessments; relevant personal or family history, relevant co-morbidities;
specifics of any prior local or systemic anti-cancer treatment(s)
2. Physical Examination: breasts and regional lymph nodes; potential organs at ___
risk within anticipated treatment field including heart, lungs, and skin
3. Imaging & Pathology: mammogram, and any ultrasound, CT or MR imaging; ___
biopsy and/or surgical findings to include histology, margins, receptors, Her2,
and lymph node status
4. TNM Staging: must be completed and accurate, according to AJCC guidelines ___
5. Plan: recommendation for treatment or not with rationale; potential side ___
effects of therapy; communication with patient and referring physician
TREATMENT
1. Simulation & Treatment Plan: documentation of positioning, technique, and ___
any required imaging; rationale for use
2. Radiation Therapy Prescription: volumes, total and fractional dose, boost or not ___
3. Physics Review: contours outlined (target tissues including tumor bed if visible, ___
lung), DVH including targets and organs at risk, isodose plan
4. On-treatment Notes: symptoms and examination, completed by physician ___
Weekly, to include emotional, nutritional, and pain assessments
5. Treatment Summary & Follow-up Plan: brief patient description including ___
TNM stage, treatment volumes and doses, any acute toxicities; communication
with referring physician
ACRO’s MOC Chart Review Template: PROSTATE Cancer
For each of the 10 criteria listed, score 1 only if ALL listed critical components have been fulfilled; score 0 if ANY component is incomplete.
CONSULTATION Score
1. Pertinent History: any urinary or systemic symptoms (if present); nutritional ___
and pain assessments; relevant personal or family history, relevant
co-morbidities; any prior local or systemic anti-cancer treatment(s)
2. Physical Examination: digital rectal exam; musculoskeletal evaluation ___
3. Imaging & Pathology: any CT or MR imaging; bone scan if high risk disease; ___
biopsy results to include Gleason score, number or percentage
of cores positive, any perineural invasion; prostatectomy findings to include
margin status, seminal vesicle invasion
4. TNM Staging: must be completed and accurate, according to AJCC guidelines ___
5. Plan: recommendation for treatment or not with rationale; potential side ___
effects of therapy; communication with patient and referring physician
TREATMENT
6. Simulation & Treatment Plan: documentation of positioning, technique, and ___
any required imaging; rationale for use
7. Radiation Therapy Prescription: volumes, total and fractional dose ___
8. Physics Review: contours outlined (target tissues including prostate; base of
seminal vesicles and/or lymph nodes if applicable), DVH including targets
and organs at risk (rectum, bladder), isodose plan
9. On-treatment Notes: symptoms and examination, completed by physician ___
weekly, to include emotional, nutritional, and pain assessments
10. Treatment Summary & Follow-up Plan: brief patient description including
TNM stage, treatment volumes and doses, any acute toxicities; communication
with referring physician