Radiation Treatment Plan Evaluation: An Educational Tool for Radiation Oncology Trainees

Background Resident education in radiation treatment plan evaluation is variable, but it is a critical component of resident education as treatment plans are patient-tailored and customized. Prior studies have reported that over 90% of residents are interested in additional resources, but most report insufficient training. We developed a case-based educational curriculum to increase confidence and competence in plan evaluation by incorporating physics and dosimetry faculty input. We used this pilot study to evaluate feasibility of implementing dedicated treatment plan evaluation teaching sessions at an academic institution. Methods A single institution pilot study with 14 volunteer residents involving pre- and post-plan evaluation teaching session. Three de-identified central nervous system (CNS) cases, including high-grade and low-grade gliomas, were selected that corresponded to the topics of the residents' clinical lectures during the time they were administered. Physics faculty and dosimetrists developed treatment plans that incorporated common problems identified during plan evaluation including inaccurate contours, excessive doses to organs at risk (OARs), suboptimal beam arrangements, and inadequate target volume coverage. An interactive, dosimetry-led teaching session reviewed the cases and tips for requesting plan changes. Residents completed anonymous follow-up surveys regarding the cases and didactic session. Results Seven of 14 (50%) eligible residents completed the three initial case surveys which took on average 11 minutes and 55 seconds to complete (range 8 minutes 39 seconds -13 minutes 50 seconds). Of the participants, most correctly identified the major issues with each case: correctly indicating which plans they would approve and the differences between plans. However, a minority of residents were able to accurately discuss more nuanced details, with only 57% and 42% correctly rejecting inaccurate contours and OAR constraints, respectively; 29% accurately listed the pros and cons of specific beam arrangements; and 14% identified techniques dosimetry could use to improve target coverage. On the follow-up survey, 100% of residents reported that both the cases and the review session improved their confidence and understanding of treatment planning and plan evaluation and stated that they would like to see similar educational material incorporated in residency training in the future. Discussion We describe an effective, multidisciplinary tool to supplement resident education in plan evaluation. This curriculum simulates frequent problems that providers face and provides tools to collaborate with dosimetry and physics to improve treatment plans. Additional follow-up on evaluating and improving confidence and preparedness with plan evaluation in independent practice is warranted. Resident education in radiation treatment plan evaluation is variable, but it is a critical component of resident education as treatment plans are patient-tailored and customized. Prior studies have reported that over 90% of residents are interested in additional resources, but most report insufficient training. We developed a case-based educational curriculum to increase confidence and competence in plan evaluation by incorporating physics and dosimetry faculty input. We used this pilot study to evaluate feasibility of implementing dedicated treatment plan evaluation teaching sessions at an academic institution. A single institution pilot study with 14 volunteer residents involving pre- and post-plan evaluation teaching session. Three de-identified central nervous system (CNS) cases, including high-grade and low-grade gliomas, were selected that corresponded to the topics of the residents' clinical lectures during the time they were administered. Physics faculty and dosimetrists developed treatment plans that incorporated common problems identified during plan evaluation including inaccurate contours, excessive doses to organs at risk (OARs), suboptimal beam arrangements, and inadequate target volume coverage. An interactive, dosimetry-led teaching session reviewed the cases and tips for requesting plan changes. Residents completed anonymous follow-up surveys regarding the cases and didactic session. Seven of 14 (50%) eligible residents completed the three initial case surveys which took on average 11 minutes and 55 seconds to complete (range 8 minutes 39 seconds -13 minutes 50 seconds). Of the participants, most correctly identified the major issues with each case: correctly indicating which plans they would approve and the differences between plans. However, a minority of residents were able to accurately discuss more nuanced details, with only 57% and 42% correctly rejecting inaccurate contours and OAR constraints, respectively; 29% accurately listed the pros and cons of specific beam arrangements; and 14% identified techniques dosimetry could use to improve target coverage. On the follow-up survey, 100% of residents reported that both the cases and the review session improved their confidence and understanding of treatment planning and plan evaluation and stated that they would like to see similar educational material incorporated in residency training in the future. We describe an effective, multidisciplinary tool to supplement resident education in plan evaluation. This curriculum simulates frequent problems that providers face and provides tools to collaborate with dosimetry and physics to improve treatment plans. Additional follow-up on evaluating and improving confidence and preparedness with plan evaluation in independent practice is warranted.