Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
J Med Imaging Radiat Oncol. 2022 Oct;66(7):993-1002. doi: 10.1111/1754-9485.13423. Epub 2022 Jun 1.
We aimed to assess contouring-related practices among US radiation oncologists and explore how access to and use of resources and quality improvement strategies vary based on individual- and organization-level factors.
We conducted a mixed methods study with a sequential explanatory design. Surveys were emailed to a random 10% sample of practicing US radiation oncologists. Participating physicians were invited to a semi-structured interview. Kruskal-Wallis and Wilcoxon rank-sum tests and a multivariable regression model were used to evaluate associations. Interview data were coded using thematic content analysis.
Survey overall response rate was 24%, and subsequent completion rate was 97%. Contouring-related questions arise in ≥50% of clinical cases among 73% of respondents. Resources accessed first include published atlases (75%) followed by consulting another radiation oncologist (60%). Generalists access consensus guidelines more often than disease-site specialists (P = 0.04), while eContour.org is more often used by generalists (OR 4.3, 95% CI 1.2-14.8) and younger physicians (OR 1.33 for each 5-year increase, 95% CI 1.08-1.67). Common physician-reported barriers to optimizing contour quality are time constraints (58%) and lack of access to disease-site specialists (21%). Forty percent (40%, n = 14) of physicians without access to disease-site specialists indicated it could facilitate the adoption of new treatments. Almost all (97%) respondents have formal peer review, but only 43% have contour-specific review, which is more common in academic centres (P = 0.02).
Potential opportunities to improve radiation contour quality include improved access to disease-site specialists and contour-specific peer review. Physician time must be considered when designing new strategies.
本研究旨在评估美国放射肿瘤学家的轮廓勾画相关实践，并探讨基于个体和组织层面因素，资源的可及性和使用情况以及质量改进策略的差异。
我们采用混合方法研究，设计顺序解释。我们向随机抽取的 10%的美国放射肿瘤学医生发送电子邮件调查。邀请参与医生进行半结构式访谈。采用 Kruskal-Wallis 和 Wilcoxon 秩和检验和多变量回归模型评估相关性。使用主题内容分析法对访谈数据进行编码。
调查的总体回复率为 24%，随后的完成率为 97%。73%的受访者表示，在≥50%的临床病例中会出现轮廓勾画相关问题。受访者首先会查阅已发表的图谱（75%），其次是咨询其他放射肿瘤医生（60%）。普通医生比疾病部位专家更常查阅共识指南（P=0.04），而 eContour.org 更常被普通医生使用（OR 4.3，95%CI 1.2-14.8）和年轻医生（每增加 5 年，OR 1.33，95%CI 1.08-1.67）。医生报告的常见轮廓质量优化障碍是时间限制（58%）和无法获得疾病部位专家（21%）。40%（40%，n=14）无法获得疾病部位专家的医生表示，这将有助于新治疗方法的采用。几乎所有（97%）的受访者都有正式的同行评审，但只有 43%的受访者有专门的轮廓评审，这在学术中心更为常见（P=0.02）。
提高放射轮廓质量的潜在机会包括改善对疾病部位专家的获取和专门的轮廓同行评审。在设计新策略时必须考虑医生的时间。
