Results From a Multi-Institutional Pilot Study of iContour, an Interactive Online Platform with Real-Time Feedback to Improve Contouring Education for Radiation Oncology Residents

Abstract

Numerous studies have shown that variability in contouring by radiation oncologists is common and associated with poor clinical outcomes. Contouring is taught via an apprenticeship model during residency with inconsistent results. Currently, there is no standardized contouring curriculum. We hypothesized that an interactive online educational platform for learners to practice contouring and receive real-time visual feedback would be a useful curricular tool. The iContour platform displays anonymized DICOM data and allows for input and analysis of user contours in a web-based interface. Nine cases are available from the Head/Neck (H+N), Gynecologic (Gyn), and Gastrointestinal (GI) disease sites. The system presents users with a case and asks them to contour representative slices from 2-3 target volumes or OARs. Upon submission, users are shown several forms of feedback. These include immediate visual comparison with expert contours on the same dataset (all cases), customized feedback based on overlap with prespecified "avoidance" and "inclusion" structures that highlight common mistakes (Gyn cases), and tumor control probability models to estimate the clinical impact of a user's contour variations on patient outcomes (H+N cases). Some cases include short videos outlining anatomy and contouring principles which are shown before the user contours. A pilot study was performed to evaluate technical performance and educational utility. Pre- and post-surveys with Likert-type questions (1-5 scale from strongly disagree to strongly agree) were used to assess user satisfaction and preferences regarding feedback. A total of 9 residents participated (median PGY3, range PGY2-5) from 5 institutions in 2 countries. Each participant completed 2 cases from a single disease site (n = 3 each for H+N, Gyn and GI), one with educational videos and one without. 67% of users had completed a prior clinical rotation in their disease site. Overall, residents felt the system was a useful educational tool (mean Likert score 4.67 +/- 0.47) and were interested in using it during clinical rotations (4.89 +/- 0.31). Most participants (7/9) felt iContour was more useful than existing resources for contouring education. Residents unanimously (9/9) found direct visual comparison with expert contours the most useful type of feedback, and that cases with videos before contouring were more educational. The iContour platform is a useful educational tool for radiation oncology residents. Participants felt receiving immediate visual feedback on contours was a valuable learning experience. Short instructional videos before contouring can be utilized to provide "just in time" teaching. A randomized study to formally assess the platform's impact on contouring skills is planned.