The Educational Impact of Web-based Platforms for Therapeutic Radiology in Sub-Saharan Africa

Purpose: This study explores the effectiveness of remote contouring training for therapeutic radiology in three Sub-Saharan African countries (Nigeria, Tanzania, Cameroon) using a web-based platform (ProKnow). Methods and Materials: A 2-hour real-time video didactic lecture and demonstration of the left parotid tumor contouring on axial CT images was delivered using the ProKnow system and a video conferencing software. Participants were granted week-long access to practice contouring of the left parotid volume after the session. Effectiveness of the remote training was evaluated with a self-assessment questionnaire administered before and after the training. Areas of competence assessed included: (i) ability to identify anatomic structure on axial CT; (ii) ability to contour a parotid volume; (iii) ability to delineate tissues; (iv) dose-volume histogram evaluation (DVH); (v) plan evaluation; (vi) port film evaluation; (vii) cone-beam CT evaluation (CBCT). A comparative statistical analysis was undertaken to evaluate for significant changes in the average self-competence score for the various competency areas before and after intervention. The post-class survey also contained questions to determine the acceptability of the ProKnow system for training and image-guided radiotherapy planning among the participants and their access to the necessary internet services. Results: There was statistically significant improvement in all skill parameters needed to contour parotid volumes on axial CT scan. Percent improvement in average self-competency scores ranged from +14.3% for DVH evaluation to +32.8% for treatment plan evaluation. Although in varying degree, 95% of participants indicated the remote training session was relevant to their clinical practice and training. Also, in varying degrees, all indicated that the web-based tool will be helpful to their professional development; that the web-based platform (ProKnow) was easy to navigate and use; and that they would recommend the resource. Most respondents (84%) had access to strong or moderate internet connectivity to integrate the web-based tools into their clinical practice and training. Conclusion: Web-based interactive contouring atlases have utility in global health, as they can serve as self-directed and remote training tools for oncology and radiology staff, which could improve the accuracy of their treatment planning and ultimately impact the quality of therapeutic radiology