Sara Beth Davis
OMDE 610-9040
March 6, 2014
Assignment #2
1
Contouring for Radiation Therapy Treatment Planning
Sara Beth Davis
University of Maryland University College
Introduction
The XXXXX Society for Radiation Oncology (XXXXX) is a medical specialty society that
provides professional development to members of the radiation oncology treatment team. Members of the
radiation oncology treatment team are responsible for all stages of a cancer patient’s treatment from initial
consultation to post-treatment care. One of the most critical aspects of safe and effective radiation therapy
is the development of the treatment plan. Radiation oncologists and other members of the treatment team
(e.g., physicists and dosimetrists) work together to develop a treatment plan using highly sophisticated
software that calculates the amount and location of radiation to tumors, while trying to spare healthy
tissue near the tumor site (XXXXX Society for Radiation Oncology, 2013).
The skill-based component using this software is called contouring and radiation oncologists
receive contouring training during their residency program. Post-residency they have a need to
continuously advance their skill set to accommodate new treatment delivery technologies, scientific
guidelines, and best practices. It is the continuing education aspect that will be addressed in this activity.
Activity Design and Delivery
The following activity is designed to evaluate a participant’s ability to identify basic anatomy,
evaluate normal tissue doses constraints versus target does objectives, and demonstrate improvement in
contouring skill. This online activity will be delivered asynchronously via computer assisted instruction to
200 radiation oncologists and will take approximately four hours to complete. The format of the activity
will include a software overview, pre-test, expert guidance, and post-test.
Sara Beth Davis
OMDE 610-9040
March 6, 2014
Assignment #2
2
The design of and participation in this activity is dependent on the use of a specially designed
web-based software program. Prior to the launch of the activity, a contouring expert will upload a series
of image slices from a CT scan of a cancer patient into the contouring software. After the images have
been uploaded, the expert must complete three steps in the contouring software to prepare the content.
The first step is to contour the healthy and diseased structures in the images. During this process the
expert will specifically identify and contour the Gross Tumor Volume (GTV), Clinical Target Volume
(CTV), and Planning Target Volume (PTV). The second step is to annotate the slices to provide a
narrative of patient history and note evidence to support the contouring methods. The third and final step
requires the expert to select three scientifically important image slices to use as the pre- and post-test
components of the activity.
Accessing the Contouring Software
The online contouring software requires that each participant has a unique login. Upon secured
log in, participants will proceed through the components of the course in a linear manner. The first
component will require participants to familiarize themselves with the contouring software by completing
an online software overview. The overview walks participants through the use of the online system and
explains how to contour the GTV, CTV, and PTV.
Pre-Test
Once a participant has finished the required software overview, they will be taken to the pre-test
portion of the activity. The pre-test component requires each participant to contour the GTV, CTV, and
PTV on the three assigned slices that the expert selected prior to the launch of the course. These three
slices record a baseline contouring score for each participant. After completing the pre-test participants
will receive a score in percentage form that indicates how similar their contours were to the expert’s
contours for each of the three assigned slices.
Expert Guidance
Sara Beth Davis
OMDE 610-9040
March 6, 2014
Assignment #2
3
After a participant completes the pre-test they will automatically move to the expert guidance
portion of the activity. In this section the expert will guide the participants through a case presentation of
the images, discuss treatment options, and outline a treatment plan that covers evidence-based GTV,
CTV, and PTV contours. The participant will not be contouring during this component.
Post-Test
The final component is a post-test activity that requires participants to contour the same three
assigned image slices that they completed in the pre-test. An expert similarity score will be provided upon
completion. It is expected that 90 percent of participants will see an improvement between their pre- and
post-test similarity scores. Students who do not receive a minimum similarity score of 70 percent will be
required to complete the expert guidance and post-test components of the course until they have reached
or surpassed a minimum similarity score of 70 percent.
Once participants have earned a passing score of at least 70 percent on the post-test they will be
taken to a activity summary page. The summary page will show their pre- and post-contours on the same
screen as the experts. These contours will be differentiated through assigned contour colors and insoftware filtering options. This gives each participant the opportunity to identify exactly where they align
and deviate from the expert’s contours, providing them with immediate feedback.
Learning Theory Implications
This activity falls under the guise of behaviorist learning theory as it “demonstrates acquisition of
knowledge or skills” (Harasim, 2012, p. 37). Participants are given clear objectives about the tasks that
they are set to perform through the activity and reward and punishment system is in effect (Harasim,
2012). In the case of this contouring activity, participants who do not earn a minimum score of 70 percent
are not able to view the expert’s contours. Instead, they receive a negative punishment and must re-take
the expert and post-test sections until they receive a passing score in order to complete the activity.
Sara Beth Davis
OMDE 610-9040
March 6, 2014
Assignment #2
4
Conclusion
In order to keep current with changing practice trends, radiation oncologists must maintain and
advance their contouring skill set. By completing pre- and post-tests, participants are able to compare
their contouring skills with experts and demonstrate an improvement in their contouring skill.
Participation in this contouring activity can lead to better treatment planning and patient outcomes.
Sara Beth Davis
OMDE 610-9040
March 6, 2014
Assignment #2
5
References
XXXXX Society for Radiation Oncology (2013). About XXXXX [website]. Retrieved from https://
www.XXXXX.org/About-XXXXX/Index.aspx
Harasim, L. (2012). Learning theory and online technologies. New York, NY: Routledge.
Appendix A
Contouring for Radiation Therapy Treatment Planning Rubric
Basic Anatomy
Contouring
Identified Gross
Tumor Volume (GTV)
Identified Clinical
Target Volume (CTV)
Identified Planning
Target Volume (PTV)
Post-test Similarity
Score
Exemplary
Proficient
Unsatisfactory
Participant scored 90
to 100% similar to
the faculty expert.
Participant scored 90
to 100% similar to
the faculty expert.
Participant scored 90
to 100% similar to
the faculty expert.
Participant scored 90
to 100% similar to
the faculty expert.
Participant scored 90
to 100% similar to
the faculty expert.
Participant scored 80
to 89% similar to the
faculty expert.
Participant scored 80
to 89% similar to the
faculty expert.
Participant scored 80
to 89% similar to the
faculty expert.
Participant scored 80
to 89% similar to the
faculty expert.
Participant scored 80
to 89% similar to the
faculty expert.
Participant scored
79% or less similar
to the faculty expert.
Participant scored
79% or less similar
to the faculty expert.
Participant scored
79% or less similar
to the faculty expert.
Participant scored
79% or less similar
to the faculty expert.
Participant scored
79% or less similar
to the faculty expert.
Overall
Weight
10%
20%
20%
20%
30%