Article Type

Original Research

Publication Date





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.


therapeutic radiology, education, radiotherapy, radiation, oncology, workforce, Africa, information and communication technology, Proknow

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© 2019 Irabor, Swanson, Oladeru, Karim, Winningham, Elzawawy, Ngwa.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.


Funding support for this project is acknowledged from the Africa Oxford Cancer Foundation (AfrOx).

Corresponding Author(s)

Omoruyi Irabor, Harvard Institute of Medicine, 4 Blackfan Circle, Boston, MA 02215, USA; Email: omi766@mail.harvard.edu