Skip to main content
SpringerLink
Log in

Assessment of contouring resource use and awareness of contouring guidelines among radiation oncologists

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Clinical questions arise frequently at the point of care, and approximately half of these questions go unanswered, representing an opportunity to improve quality of care. Radiation oncologists perform the unique task of contour delineation, which has been linked to decreased survival and increased toxicity when performed inaccurately. Little is known about how radiation oncologists approach contouring-related questions in clinical practice.

Methods

A survey was distributed to all attendees of an educational contouring symposium at the 2017 Annual Meeting of the American College of Radiation Oncology. Providers indicated their years of clinical experience and level of specialization and answered questions regarding resources used to answer contouring-related questions, awareness of consensus contouring guidelines, and barriers to guideline usage.

Results

Eighty-three out of 85 radiation oncologists attending the symposium returned the survey (97.6%). The majority of respondents were generalists (85%) and had over 10 years of clinical experience (73%). The most frequently used contouring resource was Radiation Therapy Oncology Group atlases (mean Likert score 4.1). Participants correctly identified the existence of consensus contouring guideline publications 42% of the time. The main barriers to guideline usage were a lack of awareness regarding publication (60%), poor ease of use (30%), lack of time (23%), and lack of comprehensiveness of available resources (21%).

Conclusion

This study provides information to guide further development and implementation of contouring resources, with radiation oncologists preferring resources that are atlas-based and can be accessed quickly and easily. Both self-reported and objectively tested awareness of consensus contouring guidelines was low, reflecting a need for better guideline dissemination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Segedin B, Petric P (2016) Uncertainties in target volume delineation in radiotherapy—are they relevant and what can we do about them? Radiol Oncol 50(3):254–262. https://doi.org/10.1515/raon-2016-0023

    Article  PubMed  PubMed Central  Google Scholar 

  2. Berry SL, Boczkowski A, Ma R, Mechalakos J, Hunt M (2016) Interobserver variability in radiation therapy plan output: results of a single-institution study. Pract Radiat Oncol 6(6):442–449. https://doi.org/10.1016/j.prro.2016.04.005

    Article  PubMed  PubMed Central  Google Scholar 

  3. Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D (2010) Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol 28(18):2996–3001. https://doi.org/10.1200/JCO.2009.27.4498

    Article  PubMed  Google Scholar 

  4. Ohri N, Shen X, Dicker AP, Doyle LA, Harrison AS, Showalter TN (2013) Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst 105(6):387–393. https://doi.org/10.1093/jnci/djt001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Boero IJ, Paravati AJ, Xu B, Cohen EEW, Mell LK, Le QT, Murphy JD (2016) Importance of radiation oncologist experience among patients with head-and-neck cancer treated with intensity-modulated radiation therapy. J Clin Oncol 34(7):684–690. https://doi.org/10.1200/JCO.2015.63.9898

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Del Fiol G, Workman TE, Gorman PN (2014) Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Intern Med 174(5):710–718. https://doi.org/10.1001/jamainternmed.2014.368

    Article  PubMed  Google Scholar 

  7. Ellsworth MA, Homan JM, Cimino JJ, Peters SG, Pickering BW, Herasevich V (2015) Point-of-care knowledge-based resource needs of clinicians: a survey from a large academic medical center. Appl Clin Inform 6(2):305–317. https://doi.org/10.4338/ACI-2014-11-RA-0104

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA (1991) Physicians’ information needs: analysis of questions posed during clinical teaching. Ann Intern Med 114(7):576–581. https://doi.org/10.7326/0003-4819-114-7-576

    Article  CAS  PubMed  Google Scholar 

  9. González-González AI, Dawes M, Sánchez-Mateos J et al (2007) Information needs and information-seeking behavior of primary care physicians. Ann Fam Med 5(4):345–352. https://doi.org/10.1370/afm.681

    Article  PubMed  PubMed Central  Google Scholar 

  10. Green ML, Ciampi MA, Ellis PJ (2000) Residents’ medical information needs in clinic: are they being met? Am J Med 109(3):218–223. https://doi.org/10.1016/S0002-9343(00)00458-7

    Article  CAS  PubMed  Google Scholar 

  11. Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME (2005) Answering physicians’ clinical questions: obstacles and potential solutions. J Am Med Inform Assoc 12(2):217–224. https://doi.org/10.1197/jamia.M1608

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA (2002) Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ 324(7339):710. https://doi.org/10.1136/bmj.324.7339.710

    Article  PubMed  PubMed Central  Google Scholar 

  13. Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342(8883):1317–1322. https://doi.org/10.1016/0140-6736(93)92244-N

    Article  CAS  PubMed  Google Scholar 

  14. Jagsi R, Huang G, Griffith K, Zikmund-Fisher BJ, Janz NK, Griggs JJ, Katz SJ, Hawley ST (2014) Attitudes toward and use of cancer management guidelines in a national sample of medical oncologists and surgeons. J Natl Compr Cancer Netw 12(2):204–212. https://doi.org/10.6004/jnccn.2014.0021

    Article  Google Scholar 

  15. Dillmon M, Goldberg JM, Ramalingam SS et al (2012) Clinical practice guidelines for cancer care: utilization and expectations of the practicing oncologist. J Oncol Pract 8(6):350–353 352 p following 353

    Article  Google Scholar 

  16. Somerfield MR, Bohlke K, Browman GP, Denduluri N, Einhaus K, Hayes DF, Khorana AA, Miller RS, Mohile SG, Oliver TK, Ortiz E, Lyman GH (2016) Innovations in American Society of Clinical Oncology Practice Guideline Development. J Clin Oncol 34(26):3213–3220. https://doi.org/10.1200/JCO.2016.68.3524

    Article  PubMed  Google Scholar 

  17. Han LC, Delpe S, Shah ND, Ziegenfuss JY, Tilburt JC, Karnes RJ, Nguyen PL, Gross CP, Yu JB, Trinh QD, Sun M, Ranasinghe WKB, Kim SP (2014) Perceptions of radiation oncologists and urologists on sources and type of evidence to inform prostate cancer treatment decisions. Int J Radiat Oncol Biol Phys 89(2):277–283. https://doi.org/10.1016/j.ijrobp.2014.02.001

    Article  PubMed  Google Scholar 

  18. Fuller CD, Nijkamp J, Duppen JC, Rasch CR, Thomas CR Jr, Wang SJ, Okunieff P, Jones WE 3rd, Baseman D, Patel S, Demandante CG, Harris AM, Smith BD, Katz AW, McGann C, Harper JL, Chang DT, Smalley S, Marshall DT, Goodman KA, Papanikolaou N, Kachnic LA, Radiation Oncology Committee of the Southwest Oncology Group (2011) Prospective randomized double-blind pilot study of site-specific consensus atlas implementation for rectal cancer target volume delineation in the cooperative group setting. Int J Radiat Oncol Biol Phys 79(2):481–489. https://doi.org/10.1016/j.ijrobp.2009.11.012

    Article  PubMed  Google Scholar 

  19. Mavroidis P, Giantsoudis D, Awan MJ, Nijkamp J, Rasch CR, Duppen JC, Thomas CR Jr, Okunieff P, Jones WE 3rd, Kachnic LA, Papanikolaou N, Fuller CD, Southwest Oncology Group Radiation Oncology Committee (2014) Consequences of anorectal cancer atlas implementation in the cooperative group setting: radiobiologic analysis of a prospective randomized in silico target delineation study. Radiother Oncol 112(3):418–424. https://doi.org/10.1016/j.radonc.2014.05.011

    Article  PubMed  PubMed Central  Google Scholar 

  20. Skinner A (2007) Survey research: designing an instrument. Johns Hopkins Bloomberg School of Public Health, Baltimore

    Google Scholar 

  21. AJ W, Bosch WR, Chang DT et al (2015) Expert consensus contouring guidelines for intensity modulated radiation therapy in esophageal and gastroesophageal junction cancer. Int J Radiat Oncol Biol Phys 92(4):911–920

    Article  Google Scholar 

  22. Hong TS, Bosch WR, Krishnan S, Kim TK, Mamon HJ, Shyn P, Ben-Josef E, Seong J, Haddock MG, Cheng JC, Feng MU, Stephans KL, Roberge D, Crane C, Dawson LA (2014) Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines. Int J Radiat Oncol Biol Phys 89(4):804–813. https://doi.org/10.1016/j.ijrobp.2014.03.041

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brouwer CL, Steenbakkers RJ, Bourhis J et al (2015) CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 117(1):83–90. https://doi.org/10.1016/j.radonc.2015.07.041

    Article  PubMed  Google Scholar 

  24. Niyazi M, Brada M, Chalmers AJ, Combs SE, Erridge SC, Fiorentino A, Grosu AL, Lagerwaard FJ, Minniti G, Mirimanoff RO, Ricardi U, Short SC, Weber DC, Belka C (2016) ESTRO-ACROP guideline “target delineation of glioblastomas”. Radiother Oncol 118(1):35–42. https://doi.org/10.1016/j.radonc.2015.12.003

    Article  PubMed  Google Scholar 

  25. Cox BW, Spratt DE, Lovelock M, Bilsky MH, Lis E, Ryu S, Sheehan J, Gerszten PC, Chang E, Gibbs I, Soltys S, Sahgal A, Deasy J, Flickinger J, Quader M, Mindea S, Yamada Y (2012) International Spine Radiosurgery Consortium consensus guidelines for target volume definition in spinal stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 83(5):e597–e605. https://doi.org/10.1016/j.ijrobp.2012.03.009

    Article  PubMed  Google Scholar 

  26. Illidge T, Specht L, Yahalom J, Aleman B, Berthelsen AK, Constine L, Dabaja B, Dharmarajan K, Ng A, Ricardi U, Wirth A (2014) Modern radiation therapy for nodal non-Hodgkin lymphoma-target definition and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 89(1):49–58. https://doi.org/10.1016/j.ijrobp.2014.01.006

    Article  PubMed  Google Scholar 

  27. Yahalom J, Illidge T, Specht L, Hoppe RT, Li YX, Tsang R, Wirth A (2015) Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 92(1):11–31. https://doi.org/10.1016/j.ijrobp.2015.01.009

    Article  PubMed  Google Scholar 

  28. Kastner M, Bhattacharyya O, Hayden L, Makarski J, Estey E, Durocher L, Chatterjee A, Perrier L, Graham ID, Straus SE, Zwarenstein M, Brouwers M (2015) Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: a realist review. J Clin Epidemiol 68(5):498–509. https://doi.org/10.1016/j.jclinepi.2014.12.013

    Article  PubMed  Google Scholar 

  29. Lefresne S, Olivotto IA, Joe H, Blood PA, Olson RA (2013) Impact of quality assurance rounds in a Canadian radiation therapy department. Int J Radiat Oncol Biol Phys 85(3):e117–e121. https://doi.org/10.1016/j.ijrobp.2012.10.015

    Article  PubMed  Google Scholar 

  30. Bennett CL, Somerfield MR, Pfister DG, Tomori C, Yakren S, Bach PB, American Society of Clinical Oncology (2003) Perspectives on the value of American Society of Clinical Oncology clinical guidelines as reported by oncologists and health maintenance organizations. J Clin Oncol 21(5):937–941. https://doi.org/10.1200/JCO.2003.07.165

    Article  PubMed  Google Scholar 

  31. Grimshaw JM, Thomas RE, MacLennan G et al (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8(6):iii–iiv 1-72

    Article  CAS  Google Scholar 

  32. Stafford RS, Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Furberg CD, Piller LB, Pressel SL, Whelton PK, ALLHAT Collaborative Research Group (2010) Impact of the ALLHAT/JNC7 dissemination project on thiazide-type diuretic use. Arch Intern Med 170(10):851–858. https://doi.org/10.1001/archinternmed.2010.130

    Article  PubMed  PubMed Central  Google Scholar 

  33. Flynn S, Hebert P, Korenstein D, Ryan M, Jordan WB, Keyhani S (2017) Leveraging social media to promote evidence-based continuing medical education. PLoS One 12(1):e0168962. https://doi.org/10.1371/journal.pone.0168962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Ibrahim AM, Lillemoe KD, Klingensmith ME, Dimick JB (2017) Visual abstracts to disseminate research on social media: a prospective, case-control crossover study. Ann Surg 266(6):e46–e48. https://doi.org/10.1097/SLA.0000000000002277

    Article  PubMed  Google Scholar 

  35. Bonis PA, Pickens GT, Rind DM et al (2008) Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Int J Med Inform 77(11):745–753. https://doi.org/10.1016/j.ijmedinf.2008.04.002

    Article  PubMed  Google Scholar 

  36. Isaac T, Zheng J, Jha A (2012) Use of UpToDate and outcomes in US hospitals. J Hosp Med 7(2):85–90. https://doi.org/10.1002/jhm.944

    Article  PubMed  Google Scholar 

  37. Gillespie EF, Panjwani N, Golden DW, Gunther JR, Chapman TR, Brower JV, Kosztyla R, Bykowski JM, Sanghvi P, Murphy JD (2016) Multi-institutional randomized trial testing the utility of an interactive three-dimensional contouring atlas among radiation oncology residents. Int J Radiat Oncol Biol Phys 96(2):E416–E417. https://doi.org/10.1016/j.ijrobp.2016.06.1677

    Article  Google Scholar 

Download references

Funding

The present study was supported by an American College of Radiation Oncology Education Seed Grant (to Erin F. Gillespie) and a small research grant from the Agency for Healthcare Research and Quality (grant R03HS024321 to James D. Murphy).

Author information

Authors and Affiliations

  1. Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA

    Michael V. Sherer, Alex K. Bryant, Catheryn M. Yashar, James D. Murphy & Erin F. Gillespie

  2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 22, New York, NY, 10065, USA

    Abraham J. Wu & Erin F. Gillespie

  3. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA

    Parul N. Barry

  4. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA

    Brian E. Lally

Authors
  1. Michael V. Sherer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex K. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abraham J. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Parul N. Barry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian E. Lally
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Catheryn M. Yashar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James D. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Erin F. Gillespie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erin F. Gillespie.

Ethics declarations

Conflict of interest

Erin F. Gillespie and James D. Murphy are co-founders of the non-profit contouring education website eContour (eContour.org). Michael V. Sherer, Alex K. Bryant, Abraham J. Wu, Parul N. Barry, Brian E. Lally, and Catheryn M. Yashar declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Documentation of informed consent was waived by the institutional review board.

Electronic supplementary material

ESM 1

(PDF 608 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sherer, M.V., Bryant, A.K., Wu, A.J. et al. Assessment of contouring resource use and awareness of contouring guidelines among radiation oncologists. J Radiat Oncol 7, 103–109 (2018). https://doi.org/10.1007/s13566-018-0343-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-018-0343-x

Keywords

Search

Navigation