Contouring experiences amongst Australian, New Zealand and Singaporean radiation oncology trainees. Is it enough? What next?

Abstract

This paper reports the key findings of the first survey of Australian, New Zealand (ANZ) and Singaporean radiation oncology trainees on contouring and planning. The survey was conducted from May to July 2018 using a 35-question instrument. It was emailed to all ANZ and Singaporean trainees on the Royal Australian and New Zealand College of Radiologists (RANZCR) database with at least 6 months experience. The questions related to demographics, time spent on contouring, most difficult sites to contour, most useful atlas, feedback on contouring, interaction with radiation therapists, plan reviews, stereotactic radiation therapy (SBRT), brachytherapy and suggested areas of improvement. Respondents were assured that their responses were anonymous. The response rate was 50% (54/108). Most respondents were from New South Wales (31%) with nearly all working full time (96%) and a large majority in public practice (89%). All respondents had at least one other accredited trainee at their site. The large majority (75%) spent at least two hours per week contouring, but nearly 80% had to spend some time out of hours contouring with 10% performing all their contouring out of hours. Two-thirds of respondents indicated there was insufficient time for contouring with over half having no allocated time for this activity. All respondents were allowed to independently contour by their consultants and were allowed to do radical and palliative cases. The most difficult cases to contour were head and neck and the upper gastrointestinal sites with the RTOG atlas the most useful guide. All trainee respondents received feedback on their contouring which was most often face to face. Interaction with radiation therapists was valuable and more interaction was desired. Two-thirds (67%) of respondents had the opportunity to review treatment plans with consultants with one to two cases per week being the most common numbers reviewed, but this was usually not done (87%) on an allocated time in the roster. The large majority (90%) had the opportunity to be involved in brachytherapy, but this dropped to 60% for SBRT. Three quarters (73%) of respondents felt that there was not enough time spent on contouring, planning and evaluation of plans. This initial detailed survey of ANZ and Singaporean trainees on contouring and planning indicates that dedicated protected time without interruption is required for this integral activity with current hours spent on this activity inadequate. Optimisation and improvement in a number of areas is required. Feedback from this study should be adopted by sites and networks. Feedback could also be considered as the Faculty of Radiation Oncology transitions into programmatic assessment.