Faculty of Health Science, University of Malta, Msida, Malta; Faculty of Medicine (AMC), University of Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Clin Oncol (R Coll Radiol). 2020 Jun;32(6):363-372. doi: 10.1016/j.clon.2020.01.026. Epub 2020 Feb 4.
To evaluate the impact of peer review and contouring workshops on reducing uncertainty in target volume delineation for lung cancer radiotherapy.
Data from two lung cancer target volume delineation courses were analysed. In total, 22 trainees in clinical oncology working across different UK centres attended these courses with priori experience in lung cancer radiotherapy. The courses were made up of short presentations and contouring practice sessions. The participants were divided into two groups and asked to first individually delineate (IND) and then individually peer review (IPR) the contours of another participant. The contours were discussed with an expert panel consisting of two consultant clinical oncologists and a consultant radiologist. Contours were analysed quantitatively by measuring the volume and local distance standard deviation (localSD) from the reference expert consensus contour and qualitatively through visual analysis. Feedback from the participants was obtained using a questionnaire.
All participants applied minor editing to the contours during IPR, leading to a non-statistically significant reduction in the mean delineated volume (IND = 140.92 cm, IPR = 125.26 cm, P = 0.211). The overall interobserver variation was similar, with a localSD of 0.33 cm and 0.38 cm for the IND and IPR, respectively (P = 0.848). Six participants (29%) carried out correct major changes by either including tumour or excluding healthy tissue. One participant (5%) carried out an incorrect edit by excluding parts of the tumour, while another observer failed to identify a major contour error. The participants' level of confidence in target volume delineation increased following the course and identified the discussions with the radiologist and colleagues as the most important highlights of the course.
IPR could improve target volume delineation quality among trainee oncologists by identifying most major contour errors. However, errors were also introduced after IPR, suggesting the need to further discuss major changes with a multidisciplinary team.
评估同行评议和勾画工作坊对减少肺癌放疗靶区勾画不确定性的影响。
分析了两次肺癌靶区勾画课程的数据。共有 22 名来自英国不同中心的临床肿瘤学受训者参加了这些课程，他们之前都有肺癌放疗经验。课程由简短的演讲和勾画实践组成。参与者被分成两组，首先独立勾画（IND），然后独立对另一名参与者的轮廓进行同行评审（IPR）。由两名顾问临床肿瘤学家和一名顾问放射科医生组成的专家小组对轮廓进行了讨论。通过测量与参考专家共识轮廓的体积和局部标准差（localSD）来对轮廓进行定量分析，并通过视觉分析进行定性分析。通过问卷调查获得参与者的反馈。
所有参与者在 IPR 期间对轮廓进行了细微编辑，导致勾画的平均体积（IND=140.92cm，IPR=125.26cm，P=0.211）无统计学显著减少。整体观察者间变异性相似，IND 和 IPR 的局部SD 分别为 0.33cm 和 0.38cm（P=0.848）。6 名参与者（29%）通过包括肿瘤或排除健康组织进行了正确的主要修改。一名参与者（5%）错误地排除了部分肿瘤，而另一名观察者未能发现主要轮廓错误。参与者对靶区勾画的信心在课程后有所提高，并认为与放射科医生和同事的讨论是课程的最重要亮点。
IPR 可以通过识别大多数主要轮廓错误来提高肿瘤学家受训者的靶区勾画质量。然而，IPR 后也引入了错误，这表明需要与多学科团队进一步讨论主要修改。
