ACE-RT, A Cloud-Based Tool for Remote Radiotherapy Contouring Support in Lower-Resourced Settings: A Pilot Evaluation

Area of Science:

• Medical Physics
• Radiation Oncology Education
• Digital Health

Background:

• Radiotherapy training in low- and middle-income countries (LMICs) is limited by clinician shortages and high workloads.
• Previous remote review software for radiotherapy planning faced implementation challenges in LMICs due to poor IT infrastructure and connectivity.
• There is a need for accessible digital learning tools to improve radiotherapy contouring skills in resource-limited settings.

Purpose of the Study:

• To develop and evaluate a novel cloud-based software, ACE-RT, designed to support radiotherapy planning and training in lower-resourced settings.
• To assess the feasibility, acceptability, and appropriateness of ACE-RT for improving radiotherapy contouring skills.
• To identify implementation barriers and facilitators for using digital learning tools in LMICs.

Main Methods:

• Co-design of the cloud-based ACE-RT software with radiotherapy professionals from Ghana, Zambia, and the UK, focusing on LMIC needs (bandwidth, UI, functionality).
• Evaluation of ACE-RT by a radiation oncology consultant and trainee in Indonesia over six months.
• Assessment of remote feedback provision, skill development portfolio function, and user experience.

Main Results:

• The ACE-RT software facilitated successful remote feedback on radiotherapy plans.
• Both consultants and trainees reported improved quality and quantity of feedback, and easier provision/receipt of tailored feedback.
• Users found the portfolio function valuable for tracking skill development; poor internet connectivity and file export complexity were key implementation barriers.

Conclusions:

• The cloud-based ACE-RT tool is a feasible, acceptable, and appropriate solution for enhancing radiotherapy contouring training in resource-limited settings.
• Unstable internet connectivity remains a significant barrier to the widespread implementation of such digital tools.
• Further development is recommended to optimize ACE-RT for variable internet speeds, with broader evaluation across diverse centers.