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Contouring Accuracy: The Cochlea (Pediatric)

Course Details

MDCB Credits: 1.00

ARRT Credits: 0.50

Available Until: 12/31/2021

Non-Member Price: $35.00

Member Price: $20.00

Member PLUS Price: $20.00

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Once you have exceeded your annual free credit allowance you will be prompted to pay a per-credit fee.

Courses purchased using your credit allowance are non-refundable and need to be completed before their expiration date

View your annual credit allowance here.

There are charges associated with this activity that will be processed when you access the ProKnow website. (See fees below)


In order to participate in this activity, you must use one structure token in your ProKnow account. If you don't have a structure token you can obtain one by subscribing to the Contouring Accuracy Program (see

This program focuses on contouring accuracy and combines the use of educational media (documents and learning videos) with interactive contouring. It will measure the accuracy of drawn contours against a set of "gold standard" contours provided by an expert radiation oncologist. The focus of this particular training is the pediatric cochlea.

Why do we focus on contouring accuracy? Technology continues to advance in the area of radiation treatment planning and delivery, promising ever-increasing dose conformality and, more recently, planning automation aimed to limit variability and increase efficiency. However, no matter what new technologies are developed, they all rely on (i.e., they assume) high accuracy in the contouring of targets and organs-at-risk (OAR). If anatomic contouring lacks in accuracy and/or precision, then – no matter how conformal the dose appears, or how accurate the dose calculation is proven, or how high the quality of the plan in terms of meeting prescribed objectives – that plan’s approval may be based on dose- and DVH-metrics that are not real. Therefore it is necessary that each planner produces accurate, consistent contours for all anatomy, and across all patient data sets.

Activity Instructions:

In order to complete this event and earn your CE credit, you should first associate your AAMD Member Login with your ProKnow account, as described here: Once you’ve linked your AAMD account information to your ProKnow profile and obtained the required score, your transcript in the AAMD CE Center will be automatically updated to include the relevant course within 2-4 weeks of successful completion of each structure. If you have already done this, you may skip this step.

Next, in order to access a premium structure, you must spend one of your structure tokens, which you can obtain by subscribing to the program (see: Find and select the cochlea instance for the month of January 2019, and access the structure instance using your structure token.

The Background tab provides information about the structure that you can use before you begin contouring. After you have reviewed this material you can move on to the Contour and Score tab.

The Contour and Score tab is where you will be performing your contouring. In most cases, you will use ProKnow's built-in, web-based contouring tools. (Note: A subset of structures will allow you to alternatively if desired, download the CT or MR images and contour locally using the software of your choice. You can then export as a DICOM RT Structure Set and upload that DICOM file to ProKnow’s contouring module.) When you're finished contouring and reviewing, you can select the I’m Finished button then click the Generate Score button to submit your first attempt. The time required to compute your results may vary, depending on the size of the structure, but will usually be less than one minute. After you have reviewed your results, the Learn tab will then be activated so you can view the physician walkthrough video. You will also be able to access the Population Results tab to see your results (score, Dice coefficient, volume, etc.) vs. an anonymous backdrop of your peers, as well as explore an interactive view of consensus contours overall users and vs. expert. Note: The results and 3D consensus data are constantly updating as more and more people contour the structure, so you can keep checking back in at later times to see updated population results.

To achieve your credits, you must first achieve a score greater than or equal to a high benchmark score of 75 (out of 100). This is a very sensitive scoring algorithm tailor-made for radiation therapy contouring accuracy, so do not be alarmed if your initial attempt is lower than the required threshold! You may go to the Redo and Practice tab to try again as many times as you need to obtain the threshold score. Also, please be aware that your scores are sent every two weeks from ProKnow to the AAMD so your CE credit may not appear instantaneously.

Matthew Ladra, MD, MPH

Dr. Matthew Ladra is an assistant professor of radiation oncology and molecular radiation sciences at Johns Hopkins University School of Medicine. He leads the pediatric radiation oncology program at Sibley Memorial Hospital in collaboration with Children’s National Medical Center. Dr. Ladra is a fellowship-trained pediatric radiation oncologist. He completed his radiation oncology residency at the University of Washington Medical Center in Seattle and a two-year program in pediatric proton therapy at Massachusetts General Hospital. Read more about Dr. Ladra by visiting here.


AAMD Member Prices:
Yearly Memberships price $306 (13 structures)
Monthly Memberships price $25.50 (Access to 1 structure token per month)

Non-Member Prices:
Yearly Memberships price $360 (13 structures)
Monthly Memberships price $30.00 (Access to 1 structure token per month)