Design and Prospective Assessment of a Free Online Course on Radiological Anatomy for Target Volume Delineation

Abstract

Radiological anatomy is extremely relevant to target delineation in modern radiation oncology, but is not integrated with the curriculum in most countries. We created a free online course on radiological anatomy for radiation oncology trainees and prospectively tested the effect of the learning on understanding of anatomy and target delineation skills. The teaching material for radiological anatomy was divided into 5 courses, with a total of 107 teaching modules including text, images and 3-dimensional visualizations. Twelve delineated real-life cases with more than 300 anatomical structures and anatomy-based target volumes were made available for viewing as reference contours through a third-party online portal. Three modes of assessment were used. A pre-planned pilot evaluation amongst 28 trainees in India, Nepal and the US was carried out. Students completed pre- and post-course target delineation exercises on 27 structures over different parts of the body on an online platform. The delineation accuracy was measured using area domain accuracy tests (DICE similarity), Jaccard Index and line domain accuracy tests. Compulsory student feedback was collected, and quality assessment was made using the QOCI rubric based on feedback from three expert faculty members. Twenty-one students completed all assessments. Mean scores of the pre-course quiz showed a baseline score of 21.1/35 (60.2%) which increased to 54.5 /69 (78.9%) in the combined post-course evaluations (p < 0.001, paired T test). Of the 27 structures, the DICE similarity coefficient improved by more than 5% in 21 structures and more than 10% in 17 structures. The Jaccard Index improved by more than 10% in 18 structures. The line domain errors reduced in all but one structure. The course content was rated highly (excellent or good) by more than 85% participants. The course images and media were rated highly by more than 80% participants. The course met expectations on most criteria on the QOCI rubric except for group-work and combined audio-video teaching. The course was released in late 2018 with free unrestricted access. This free online course resulted in an improvement in understanding of anatomy relevant to radiation oncology and target delineation skills. The online medium can be explored further for teaching of complex skills relevant to this field to enable greater access across the world.