Enhancing IMRT/VMAT Competencies in LMICs globally within radiation physicists through remote training.

Abstract

High-quality intensity-modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT) is necessary to drive positive patient outcomes, yet gaps in staff training hinder its implementation in low-to-middle-income countries (LMICs). This work aimed to evaluate a large-scale remote training curriculum for medical physicists and clinicians with existing IMRT infrastructure in LMICs. A 15-week free, virtual course with weekly live sessions incorporating didactics and case-based learning led by expert volunteers was conducted. The first 500 registrants were accepted into the program. Participants' confidence and knowledge was evaluated via pre- and post-course surveys on a 1-5 Likert scale across seven IMRT/VMAT domains and through 11 multiple-choice questions. Participants also created treatment plans for standardized bilateral head-and-neck cancer cases, assessed by eight expert volunteers using qualitative rubrics and quantitative scorecards on the ProKnow DS platform. Performances were compared using Wilcoxon signed-rank tests. A total of 240 medical physicists, medical physics residents, and dosimetrists responded to both the pre- and post-course surveys. Mean confidence scores increased from 3.00/5 (SD: 1.04) to 3.80/5 (0.87) (p < 0.001). Knowledge scores improved from 4.16/11 (SD: 1.77) to 5.98/11 (SD: 2.11) (p < 0.001). Additionally, 33 participants completed both the pre-course and post-course treatment planning assignments. Automated scorecard performance significantly improved from 12.64/25 (SD: 7.50) to 17.74/25 (SD: 6.74) (p = 0.0004). Grading rubric scores did not significantly change, from 9.15/14 (SD: 3.33) to 9.76/14 (SD: 2.65) (p = 0.4). The virtual IMRT/VMAT curriculum significantly enhanced knowledge, confidence, and treatment planning skills among participants, demonstrating a scalable, low-cost intervention for improving IMRT/VMAT implementation in LMICs.