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Introduction Image registration and delineation of organs at risk (OARs) are key components of three‐dimensional conformal (3DCRT) and intensity‐modulated radiotherapy (IMRT) treatment planning. This study hypothesized that image registration and OAR delineation are often performed by medical physicists and/or dosimetrists and are not routinely reviewed by treating physicians. Methods An anonymous, internet‐based survey of medical physicists and dosimetrists was distributed via the MEDPHYS and MEDDOS listserv groups. Participants were asked to characterize standard practices for completion and review of OAR contouring, target volume contouring, and image registration at their institution along with their personal training in these areas and level of comfort performing these tasks. Likert‐type scales are reported as Median [Interquartile range] with scores ranging from 1 = “Extremely/All of the time” to 5 = “Not at all/Never.” Results Two hundred and ninety‐seven individuals responded to the survey. Overall, respondents indicated significantly less frequent physician review (3 [2–4] vs 2 [1–3]), and less confidence in the thoroughness of physician review (3 [2–4] vs 2 [1–3], P < 0.01) of OAR contours compared to image registration. Only 19% (95% CI 14–24%) of respondents reported a formal process by which OAR volumes are reviewed by physicians in their clinic. The presence of a formal review process was also associated with significantly higher perceived thoroughness of review of OAR volumes compared to clinics with no formal review process (2 [2–3] vs 3 [2–4], P < 0.01). Conclusion Despite the critical role of OAR delineation and image registration in the 3DCRT and IMRT treatment planning process, physician review of these tasks is not always optimal. Radiotherapy clinics should consider implementation of formal processes to promote adequate physician review of OARs and image registrations to ensure the quality and safety of radiotherapy treatment plans.

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