BACKGROUND AND PURPOSE EMBRACE-II is an international prospective study of IMRT and MRI-guided adaptive brachytherapy (IGABT) in locally advanced cervix cancer. An online radiotherapy quality assurance (RTQA) programme with minimal data transfer and supporting continuing medical education (CME) was implemented for IMRT contouring. MATERIALS AND METHODS Participant contours for six volumes-of-interest (VOIs) on one benchmark case were scored (2 = excellent, 1 = fair, 0 = revision required) against a consensus reference contour. For contours receiving a 0 or 1 score, additional qualitative comments were provided. The Jaccard conformity index (JCI) was retrospectively calculated. User interaction with CME content (pre-accreditation questionnaire, contouring atlas, practice cases, quizzes, internal target volume (ITV-T) guide) was analysed. RESULTS 78 clinicians submitted contours for evaluation. 41% passed at the first attempt, 44% after one revision and 6% after two or more revisions. 9% did not re-submit after failing. The lowest mean scores were for the elective nodal CTV (CTV-E) (1.01/2) and ITV-T (1.06/2). 60 different errors across the six VOIs were identified; five potentially had high impact on loco-regional control. A JCI cut-off of 0.7 would have identified 87% contours that failed expert assessment, but also excluded 54% of passing contours. 39 clinicians responded to the pre-accreditation questionnaire - 36% anticipated difficulties with the ITV-T and 13% with the CTV-E. 35% clinicians contoured on the practice cases, 17% answered a quiz, 96% used the atlas and 38% the ITV-T guide. CONCLUSION Expert evaluation with qualitative feedback improved contouring compliance. The JCI is not a reliable alternative to expert assessment. Moderate uptake of optional CME content limited evaluation.

中文翻译：

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实施在线放射治疗质量保证计划，支持继续医学教育——来自子宫颈癌 IMRT 轮廓的 EMBRACE-II 评估报告

背景和目的 EMBRACE-II 是一项针对局部晚期宫颈癌的 IMRT 和 MRI 引导的适应性近距离放射治疗 (IGABT) 的国际前瞻性研究。为 IMRT 轮廓绘制实施了具有最少数据传输和支持继续医学教育 (CME) 的在线放射治疗质量保证 (RTQA) 计划。材料和方法 根据共识参考轮廓对一个基准案例中六个感兴趣体积 (VOI) 的参与者轮廓进行评分（2 = 优秀，1 = 中等，0 = 需要修改）。对于获得 0 或 1 分的轮廓，提供了额外的定性评论。Jaccard 一致性指数 (JCI) 是回顾性计算的。分析了用户与 CME 内容（预认证问卷、轮廓图集、练习案例、测验、内部目标量 (ITV-T) 指南）的交互。结果 78 名临床医生提交了轮廓进行评估。第一次尝试通过率为 41%，一次修改后为 44%，两次或更多次修改后为 6%。9% 失败后没有重新提交。最低平均分数是选择性节点 CTV (CTV-E) (1.01/2) 和 ITV-T (1.06/2)。确定了六个 VOI 中的 60 个不同错误；五个可能对本地区域控制产生重大影响。0.7 的 JCI 临界值将识别出 87% 未通过专家评估的等值线，但也排除了 54% 的合格等值线。39 名临床医生对预认证问卷做出了回应——36% 的人预计 ITV-T 会遇到困难，13% 的人预计 CTV-E 会遇到困难。35% 的临床医生概述了实践案例，17% 回答了测验，96% 使用了地图集，38% 使用了 ITV-T 指南。结论 带有定性反馈的专家评估提高了轮廓合规性。JCI 不是专家评估的可靠替代方案。适度采用可选的 CME 内容有限评估。