Multi-institutional randomized trial testing the utility of an interactive 3-dimensional contouring atlas among radiation oncology residents

Publication date: Available online 9 December 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erin F. Gillespie, Neil Panjwani, Daniel W. Golden, Jillian Gunther, Tobias R. Chapman, Jeffrey V. Brower, Robert Kosztyla, Grant Larson, Pushpa Neppala, Vitali Moiseenko, Julie Bykowski, Parag Sanghvi, James D. Murphy
PurposeThe delivery of safe and effective radiation therapy relies on accurate target delineation, particularly in the era of highly conformal treatment techniques. Current contouring resources are fragmented and can be cumbersome to use. This study reports on the efficacy and usability of a web-based contouring atlas compared to existing contouring resources in a randomized trial.MethodsWe enrolled radiation oncology residents onto a two-phase contouring study. All residents contoured a T1N1 nasopharyngeal cancer case using currently available resources. Participants were then randomized to re-contour the case with access to existing resources or to an interactive web-based contouring atlas (eContour.org). Contour analysis was performed using conformation number and simultaneous truth and performance level estimation (STAPLE). At the completion of the second contouring session, residents completed a multiple choice question (MCQ) knowledge test and a 10-item System Usability Scale.ResultsTwenty-four residents from five institutions completed this study. Compared to residents using currently available resources, residents using eContour had improved contour agreement with both the consensus (0.63 vs. 0.52, p = 0.02) and expert (0.58 vs. 0.50, p = 0.01) contours for the high risk clinical target volume, and greater agreement with the expert contour for the contralateral parotid (0.44 ± 0.12 vs. 0.56 ± 0.08, p = 0.003). Residents using eContour demonstrated greater knowledge of contour delineation and radiographic anatomy on a multiple-choice question test (89% vs. 77%, p=0.03). Usability (89 vs. 66, p<0.0001), and satisfaction (4.1 vs. 3.0, p=0.002) were higher for eContour compared to existing resources.ConclusionThis study demonstrates the capacity of an interactive 3-dimensional contouring atlas to improve quality of resident target delineation in radiation oncology. Further research is needed to define the utility of easily accessible interactive educational reference tool to improve adherence to contouring-based guidelines and quality of care in routine clinical practice.



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