An assessment of skill erosion on high‐dose rate brachytherapy treatment planning

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PURPOSE: To assess skill erosion for physicists after leaving brachytherapy service and contributors to variability during brachytherapy treatment planning. METHODS: Medical physicists simulated planning for nine patients by creating treatment plans twice, 2 months apart. The physicists were stratified as "On-Service" if they were assigned to and actively participating in the brachytherapy service (including treatment planning) during the study or "Off-Service" if they were not assigned, were not actively engaged in the service, and had not performed treatment planning the 6 months prior to the study commencement or during the study. A mixed effects model with Bonferroni correction was used to test for statistical significance between the stratified groups and Cohen's D was used to compare the effect of skill erosion. ANOVA analysis of a crossed Gauge Repeatability and Reproducibility (Gauge R&R) study quantified three contributors to variability for eight segments of the planning process: [1] repeatability (intra-observer), [2] reproducibility (inter-observer), and [3] patient-to-patient variation. Process capability was deemed acceptable when the Total Gauge R&R was less than 10%, marginally acceptable between 10% and 30%, and unacceptable when greater than 30%. RESULTS: The group of On-Service study participants had lower variability on 10 of 19 measures in the brachytherapy planning process than Off-Service study participants with the effect size being small, Cohen's D between 0.15 and 0.30 for significant measures. This indicates skill erosion does affect physicists after leaving the brachytherapy service for a period of 6 months or more. For both groups, only the bladder D2cc metric had a controlled amount of variability other than applicator reconstruction. CONCLUSIONS: Brachytherapy treatment planning suffers from skill erosion. Physicists should seek to mitigate its effects and evaluate competency on an ongoing basis.

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