Radiation Oncology History/Education/Social Media

PV QA 3 - Poster Viewing Q&A 3

TU_45_2929 - Long-term impact on contouring skills achieved by online learning. An ESTRO-FALCON-IAEA study

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Long-term impact on contouring skills achieved by online learning. An ESTRO-FALCON-IAEA study
S. Rivera1, C. Petit2, A. Navarro Martin3, J. Cacicedo4, O. Leaman5, M. C. Atencio Rosselot6, A. Lazaryan7, K. Akperov8, V. Sinaika9, R. Monestel10, A. Fröbe11, G. Kevlishvili12, I. R. Stojkovski13, B. Magsar14, M. Corovic15, H. Mahmood16, Z. Alauddin17, O. Barriga18, M. Lucas19, M. Palmu20, E. Zubizarreta21, K. Hopkins21, and J. G. Eriksen22; 1Institut Gustave Roussy, Villejuif, France, 2igr, villejuif, France, 3Instituto catalan de oncologia, Barcelona, Spain, 4Cruces University Hospital, Bilbao, Spain, 5Spanish National Cancer Research Centre, Madrid, Spain, 6Fundación Escuela de Medicina Nuclear, Mendoza, Argentina, 7National Center of Oncology, Yerevan, Armenia, 8National Centre of Oncology, Baku, Azerbaijan, 9N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus, 10Caja Costarricense del Seguro Social, San Jose, Costa Rica, 11University Hospital Center, Sestre Milosrdnice, zagreb, Croatia, 12High Technology Medical Center, Tblisi, Georgia, 13University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The former Yugoslav Republic of, 14National Cancer Centre, Ulaanbaatar, Mongolia, 15Radiotherapy Dept, Clinical Centre of Montenegro, Podgorica, Montenegro, 16Nuclear Medicine, Oncology and Radiotherapy Institute, Islamabad, Pakistan, 17Institute of Nuclear Medicine and Oncology, Islamabad, Pakistan, 18Centro de Radioterapia de Lima, lima, Peru, 19ONCOSUR, Florida, Uruguay, 20ESTRO, Brussels 1200, Belgium, 21International Atomic Energy Agency, Vienna, Austria, 22Odense University Hospital, Odense, Denmark

Purpose/Objective(s): The weakest point in conformal radiotherapy (RT) is heterogeneity in contouring of target volumes (TV) and organs at risk (OAR). Interactive online learning has shown immediate improvement of homogeneity in contouring but the long-term effect is unknown. The aim of this multicenter study was to evaluate the short- and long-term impact of online learning on homogeneity in contouring for 3D RT and to evaluate the feasibility of blended learning in centers from low- and middle-income countries (LMIC) that have recently transitioned from 2D to 3D RT.

Materials/Methods: 60 Radiation Oncologists (RO) from 14 centers in 13 countries were invited. Participants delineated TV and OAR on a treatment planning CT in the FALCON-EduCase online system. The teaching program involved 3 tumor sites: head and neck (HN), lung and cervix. Four delineations per tumor site were planned: one before the teaching period, 2 during the teaching period (at 1 week and 1 month) and finally a fourth without teaching 6 months later. As soon as one teaching program had finished another started for another site. In total 12 delineations for 3 cases were contoured over a year. Participants were blind to the DICE index and qualitative measures which would be used as endpoints.

Results: Compliance to the program was >50%. The majority (88%) used 3D RT routinely. For HN part, 57 RO delineated, significant increases were seen in homogeneity of contouring for TV and OAR. DICE increased immediately during the teaching sessions and remained high even 6 months after teaching (p<0.0001 for the elective CTV and right parotid for example). That was also reflected qualitatively with an increase from 4% to 94% RO delineating the levels suggested by the guidelines after 6 months. Similar improvements were recorded for OAR. For the cervical cancer part, 46 RO delineated, significant increases were seen in homogeneity of contouring for TV and OAR except for sigmoid colon (table 1). CTV T and N DICE increased immediately after teaching and remained high after 1 month and showed a slight decreasing trend at 6 months. Similar results were recorded for OAR, such as bladder and rectum (table 1). Qualitative improvement was observed with an increase from 12% to 79% and 59% of the RO who correctly included parametria in the CTV T from first delineation to the delineation at 1 month and at 6 months, respectively. The trend to partly lose learning benefit was also seen with this qualitative analysis.

Conclusion: Online teaching in LMIC seems feasible with an acceptable compliance to the learning program. The learning obtained on a short-term basis was shown to be sustainable 1 and 6 months after teaching but the benefit might be decreasing over time suggesting the need for continuous medical education in the field of contouring. Table 1: Mean DICE for TV and OAR of cervical cancer case
before lecture (n=30) 1 week (n=35) 1 month (n=19) 6 months (n=27)
CTV T 0.58 0.77 0.79 0.71
CTV N 0.51 0.67 0.71 0.61
Rectum 0.65 0.72 0.74 0.68
Bladder 0.64 0.80 0.80 0.74
Sigmoid 0.19 0.20 0.23 0.21

Author Disclosure: S. Rivera: None. C. Petit: None. A. Navarro Martin: None. J. Cacicedo: None. m. Atencio Rosselot: None. K. Akperov: None. G. Kevlishvili: None. I.R. Stojkovski: None. J. Eriksen: MD; Aarhus University Hopsital.

Jesper Grau Eriksen, MD, PhD

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