Radiation therapists' knowledge and training needs regarding pelvic organ preparation in endometrial cancer radiotherapy: a multicenter cross-sectional survey of the radiotherapy health workforce

Abstract Background For endometrial cancer (EC) patients receiving radiotherapy, optimal pelvic organ (bladder and rectum) preparation is essential for treatment accuracy, target coverage, and organ-at-risk sparing. Radiation therapists (RTs) are the frontline staff responsible for verifying patient preparation and image-guided radiotherapy (IGRT) setup prior to each fraction; however, the magnitude of the subjective-objective knowledge gap and the training needs regarding pelvic organ preparation in this workforce have not been quantified at a national scale.This represents a modifiable health-system and workforce-competence gap with direct implications for quality of care. Methods A cross-sectional, mixed-methods online survey was conducted from 1 May to 30 June 2025 among 375 radiation therapists across 23 centers nationwide; quantitative and qualitative responses were analyzed. A 10-point Likert scale categorized qualitative responses. Results 242 therapists from 20 centers completed the survey (response rate, 64.5%). Although therapists reported high subjective confidence, objective questions revealed low correct rates (range: 10.4%-61.8%). Therapists showed high awareness of image-guided radiotherapy (IGRT) (mean, 8.95) but limited use of IGRT and monitoring devices. Only 68.6% (166/242) reported prior training. In a post-hoc subgroup analysis, prior training was not associated with significantly higher objective accuracy on the specialised questions, although trained therapists reported higher subjective confidence. Lack of training opportunities and time constraints were the greatest barriers. Respondents endorsed enhanced training (mean, 8.90), preferring hands-on short intensive sessions. The most required topic was the detailed extent of bladder filling and rectal emptying (96.3%). Conclusions A gap between subjective confidence and objective pelvic-organ-preparation knowledge was identified among Chinese radiation therapists. Future training with hands-on practice through short, intensive sessions on the topic of detailed extent of bladder filling and rectal emptying is most desired. Notably, in a post-hoc subgroup analysis, prior training was linked to higher self-rated confidence but not to greater objective accuracy, indicating that training quality—rather than mere exposure—is what matters and pointing to a curriculum blind spot. Findings generalize to countries where therapist training overlaps with diagnostic imaging rather than radiation oncology.