The impact of an educational tool in cervix image registration across three imaging modalities.

Abstract

OBJECTIVES Accurate image registration is vital in cervical cancer where changes in both planning target volume (PTV) and organs at risk (OAR) can make decisions regarding image registration complicated. This work aims to determine the impact of a dedicated educational tool compared with experience gained in MR guided radiotherapy (MRgRT). METHODS Ten therapeutic radiographers acted as observers and were split into two groups based on previous experience with MRgRT and Monaco treatment planning system. Three CBCT- CT, three MR-CT and two MR-MR registrations were completed per patient by each observer. Observers recorded translations, time to complete image registration and confidence. Data was collected in two phases; prior to and following the introduction of a cervix registration guide. RESULTS No statistically significant differences were noted between imaging modalities. Each group was assessed independently pre and post education, no statistically significant differences were noted in either CBCT-CT or MR-CT imaging. Group one MR-MR imaging showed a statistically significant reduction in inter-observer variability (p=0.04), in group two, the result was not statistically significant (p=0.06). Statistically significant increases in confidence were seen in all three modalities (p≤0.05). CONCLUSIONS At our institution radiographers consistently registered images across three different imaging modalities regardless of their previous experience. The implementation of an image registration guide had limited impact on inter and intra-observer variability. Radiographers' confidence showed statistically significant improvements following the use of the registration manual. ADVANCES IN KNOWLEDGE This work helps evaluate training methods for novel roles that are developing in MRgRT.