Contouring Training

[Haybrant]

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My contouring is horrendous. When I've suggested with attendings that I watch them contour that is looked heavily down upon. I call absolute BS on this. Do surgeons not allow their trainees to watch them operate? Its completely different than going back and looking through the case later. Anyone watch their attendings contour? are they even that good?

 

[Seldon1985]

My contouring is horrendous. When I've suggested with attendings that I watch them contour that is looked heavily down upon. I call absolute BS on this. Do surgeons not allow their trainees to watch them operate? Its completely different than going back and looking through the case later. Anyone watch their attendings contour? are they even that good?

Best part of my first rotation as a PGY2 was when my top notch attending didn't mind when I watched him contour. I certainly picked up skills that Ive used on every rotation since.

 

[BraggPeak]

Contouring is more art than science. Everyone does it differently. Take 3 attendings, have them contour the same patient, and you will get 4 different volumes.

Having said that, all your attendings should be going over your contours. They should be spending more time doing this early in your residency. You might also consider buying Nancy Lee's new book and also look at RTOG atlases.

Sometimes I create my gtv/ctv/ptv contours and then copy the structures and have the attending approve/modify them. Later, you can go back and compare the two contours to see exactly what they changed.

It gets better as you get more senior...

 

[deleted4401]

Are you a PGY-2? If yes, of course it's horrendous! You have no idea what you're doing. It's a performance sport. Gotta practice before the attending gets there, turn your contours off and let them do theirs. Look at the difference. Ask them way theirs goes more lateral or is more expansive or whatever. Use the RTOG atlases. Read the seminal papers - there are for most sites. Contouring and field design should be very rational. Though there is art, the art should be millimeters, not centimeters. The art is whether to include a particular level of LN based on evidence, not necessarily how to contour it. There should be considerable overlap between attendings contours and what the atlas says (like 95 percent, otherwise they are doing it wrong).

It sucks your mentors are not helping you. I suggest you go to astro contouring sessions or other ones - UPMC does an IMRT contouring session with their physics company D3. Sign on to chartrounds.com and watch those cases. Btw, does anyone feel that there are way too many zebras on chartrounds? They should push for "normal" cases, too, just to make sure people know what the hell they are doing.

 

[Haybrant]

Are you a PGY-2? If yes, of course it's horrendous! You have no idea what you're doing. It's a performance sport. Gotta practice before the attending gets there, turn your contours off and let them do theirs. Look at the difference. Ask them way theirs goes more lateral or is more expansive or whatever. Use the RTOG atlases. Read the seminal papers - there are for most sites. Contouring and field design should be very rational. Though there is art, the art should be millimeters, not centimeters. The art is whether to include a particular level of LN based on evidence, not necessarily how to contour it. There should be considerable overlap between attendings contours and what the atlas says (like 95 percent, otherwise they are doing it wrong).

It sucks your mentors are not helping you. I suggest you go to astro contouring sessions or other ones - UPMC does an IMRT contouring session with their physics company D3. Sign on to chartrounds.com and watch those cases. Btw, does anyone feel that there are way too many zebras on chartrounds? They should push for "normal" cases, too, just to make sure people know what the hell they are doing.

Good advice simulD. Truthfully though, i have seen some some very questionable volumes in attending contours and I think it points to a more systemic issue with rad onc. Everyone is in a rush and money hungry it seems, nobody will sit down and teach the trade. In 2 years I've met almost no role models, no good teachers. Very different from how surgeons and med onc trainees feel about their attendings who command respect and are respected for their technique

 

[deleted4401]

That's your program, not the field 🙁

 

[Gfunk6]

I agree with SimulD, that it is probably your program. In my training it was often older attendings that took the time to teach contouring and the "old school" way to do things (e.g. fluoroscopic simulations, contouring 3D anatomy anyway when doing a four field box, contouring 'extra' normal structures for instructional purposes).

Some sites, like H&N, are notoriously difficult to learn due to the variance between attendings (as mentioned above) and the high density of overlapping structures. Although RTOG atlases are useful in these cases, you REALLY need to have an attending to critique your contours and be brutally honest. I've made some pretty bone-headed contouring errors in training that were not obvious to me until pointed out by an attending.

 

[RadOncDoc21]

I think you need to realize that this is "your" residency and have to take out of it all that you can get. I use to sit back and not ask many questions but over the past few months I realized this is the time to ask all the questions and soak in as much information before I'm out in the world treating the parotid gland to 70 Gy because I thought it was my GTV!

 

[stems]

We need to work together to get rid of these residency programs who use residents as cheap labor

 

[OTN]

My contouring is horrendous. When I've suggested with attendings that I watch them contour that is looked heavily down upon. I call absolute BS on this. Do surgeons not allow their trainees to watch them operate? Its completely different than going back and looking through the case later. Anyone watch their attendings contour? are they even that good?

Complete BS that your attendings won't let you even watch them contour. Utterly ridiculous. I would complain first to the program director, then the department head, and finally the dean of the med school, in that order, to get results. Do it in person and in writing to have a paper trail. If they retaliate against you talk directly with the ACGME.

It is simply not acceptable that your program is violating the basic resident contract: You do the ****ty work in exchange for teaching. Not acceptable.