D. A. S. Toesca, J. Gagneur, S. H. Patel, J. C. M. Rwigema, and L. A. McGee; Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
Purpose/Objective(s): This study evaluated the utility of incorporating contour grading through a formal head and neck (HN) contour peer-review (PR) process to objectively assess radiation oncology (RO) resident physician target volume contour delineation in patients with HN cancer undergoing radiation therapy. Materials/
Methods: Target volumes from consecutive patients diagnosed with primary HN malignancies treated in a single institution were contoured by RO residents during HN service rotations and were formally peer-reviewed. Contours were peer-reviewed by a minimum of two HN RO attendings and assigned a grade as follows: R0 (no change recommended); R1 (minor revision recommended, not clinically significant); R2 (major revision recommended, deemed clinically significant). The PR process allowed for immediate feedback to the RO residents, suggesting target volume modifications as deemed necessary. Contour grades for each case were recorded within a PR task item built into the care path of the electronic medical record. Progression of RO resident HN contouring skills was assessed by postgraduate year (PGY) in training. Confidence intervals were calculated based on Student’s t test method. Results: The formal PR process started in 2018. Formal contour PR was performed for 218 HN cancer patients contoured by 6 RO residents over the study period. Of which, 48 (22%) cases were contoured by PGY2 residents, 98 (45%) by PGY3, 40 (18%) by PGY4, and 32 (15%) by PGY5 residents. We observed an objective improvement in contour review grades and reduced need for target volume modifications across the different academic years, with a mean score of 1.43 [Standard deviation (SD) = 0.71; confidence interval (CI) = 0.2] for PGY2 trainees, 0.99 (SD = 0.81; CI = 0.16) for PGY3, 0.93 (SD = 0.92; CI = 0.29) for PGY4, and 0.69 (SD = 0.64; CI = 0.23) for PGY5 RORP trainees. Improvement in scores was consistent among the evaluated RO residents, with absolute mean improvement of -0.2 for resident #1, -0.32 for resident #2, -0.82 for resident #3, -0.4 for resident #4, -1.33 for resident #5, and -0.56 for resident #6. Conclusion: Incorporating a formal HN contouring PR process and contour grade assignment into routine clinical evaluation of RO residents is feasible. This process objectively estimated the quality of HN target volumes created by RO residents and demonstrated objective improvement with advancement of PGY training. We believe this metric is a useful tool which could be used to predict readiness for independent practice and could be readily implemented into clinical practice workflow, potentially improving the quality of RO resident evaluation during postgraduate medical education.
