Training activity information
Details
Outline treatment planning volumes on a TPS including external contours, OARs, PRVs, PTVs, planning volumes for a range of patients covering different anatomical sites
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Documentation including ICRU
- Derivation of planning growth margins
- Basic CT anatomy
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like for outlining treatment planning volumes on a TPS? What are the expected standards for accurate and comprehensive contouring of target volumes (PTVs) and organs at risk (OARs) across different anatomical sites? How will you ensure that all relevant volumes are correctly defined according to clinical protocols and anatomical guidelines?
- What is your prior experience with contouring and anatomical delineation in a TPS? What knowledge do you possess regarding anatomical landmarks, contouring guidelines e.g., ICRU, and the tools available in the TPS? What challenges might you encounter e.g., complex anatomy, motion artifacts, and what strategies do you have to overcome them? When would it be appropriate to seek guidance from a consultant clinical oncologist or an experienced clinical scientist regarding contouring decisions? What are your feelings about the responsibility of accurately delineating patient volumes?
- What specific skills in anatomical delineation, TPS tool usage, or adherence to contouring protocols do you aim to develop or improve? What insights do you hope to gain regarding the variability in patient anatomy and the critical importance of accurate volume outlining for treatment delivery?
- Have you reviewed any previous feedback or established best practices for contouring different anatomical sites? What important information, such as patient imaging (CT, MRI, PET), clinical notes, or specific departmental contouring atlases, should you review?
In action
- You make a note of anything that feels surprising or different from what you anticipate, such as:
- Ambiguous or unclear anatomical boundaries on the CT images.
- Difficulty in differentiating between OARs and target volumes due to patient anatomy or image quality.
- Software auto-contouring errors or limitations.
- Unforeseen challenges in applying departmental or clinical guidelines for specific anatomical sites.
- You consider how this specific experience compares with previous experiences of similar activities. Is this complexity unique to this patient or a common challenge for this anatomical site?
- How do you react to the unexpected development?
- Do you respond appropriately e.g., do you cross-reference with other imaging modalities, consult anatomical atlases, or review clinical notes?
- Do you adapt or change your approach to contouring e.g., using different tools, adjusting display settings, or changing your contouring strategy?
- Does it affect your ability to undertake the activity independently e.g., do you identify the need for clinical input or a second opinion from a senior physicist/clinician?
- Do you find it difficult to adapt? Do you feel confident in your anatomical knowledge and contouring skills?
- Does it affect your confidence in accurately defining the volumes for treatment planning?
- Do you feel positive you can reach a successful conclusion, ensuring patient safety?
- You identify how you work within your scope of practice to address the unexpected development. Do you ensure that all volumes are clinically relevant and accurate? You identify what you learn in the moment as a result of the unexpected development (e.g., a specific anatomical landmark, a contouring technique for a challenging area, or the importance of multi-modality imaging).
On action
- Begin by summarising the key points of your experience outlining treatment planning volumes on a TPS for various anatomical sites. Consider specific events, actions, or interactions which felt important during the contouring process, including your own feelings at the time. Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded during the contouring process.
- Identify what learning you can take from this experience of outlining treatment planning volumes e.g., what strengths did you demonstrate? What skills and/or knowledge gaps were evident? Compare this experience against previous engagement with similar volume outlining activities – were any previously identified actions for development achieved? Has your practice improved in outlining volumes for different anatomical sites? Identify any challenges you experienced during the contouring process and how you reacted to these e.g., did this affect your ability to deal with the situation? Were you able to overcome the challenges? Identify anything significant about this activity of outlining planning volumes e.g., did you need to seek advice or clarification regarding anatomical structures or contouring guidelines? Or did you need to escalate to ensure that you were working within your scope of practice? Acknowledge any changes in your own feelings now that you are looking back on the experience of outlining treatment planning volumes.
- Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt from this activity, including from any feedback you have received e.g., what will you do differently next time you outline planning volumes? Has anything changed in terms of what you would do if you were faced with a similar volume outlining situation again? Do you need to practise any aspect of volume outlining further?
Beyond action
- Have you reviewed the actions you identified for improvement from your prior reflections on this activity? For example, did you aim to improve your consistency in contouring Organs at Risk (OARs), your understanding of Planning Target Volume (PTV) margins, or your speed across different anatomical sites? Have you completed these actions, and are you ready to demonstrate this refined skill? Has discussing these experiences with others clarified your understanding of anatomical variations, clinical guidelines, or the impact of contouring on dose distribution?
- Consider how this learning will support you in preparing for observed ‘in-person’ assessments, particularly those related to treatment planning. Reflect on how your contouring practice has developed and evolved over time. Do you now more readily identify discrepancies or ambiguities in imaging for contouring, and do you recognise when a complex case necessitates input from a senior colleague or a multidisciplinary team meeting?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply appropriate guidance, regulations and codes of practice to ensure patient safety in all elements of practice. |
| # 4 |
Outcome
Identify appropriate immobilisation techniques to ensure accuracy of treatment delivery. |
| # 5 |
Outcome
Explain and critically analyse the use of pre-treatment and on-treatment imaging within radiotherapy. |
| # 6 |
Outcome
Develop and appraise external beam radiotherapy treatment plans for clinical use. |