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Brunner TB, Boda-Heggemann J, Bürgy D, Corradini S, Dieckmann UK, Gawish A, Gerum S, Gkika E, Grohmann M, Hörner-Rieber J, Kirste S, Klement RJ, Moustakis C, Nestle U, Niyazi M, Rühle A, Lang ST, Winkler P, Zurl B, Wittig-Sauerwein A, Blanck O. Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery. Strahlenther Onkol 2024; 200:737-750. [PMID: 38997440 PMCID: PMC11343978 DOI: 10.1007/s00066-024-02254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE AND OBJECTIVE To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs. MATERIALS AND METHODS Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60-79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process. RESULTS Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60-79% consensus. CONCLUSION In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT.
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Affiliation(s)
- Thomas B Brunner
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Bürgy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Ute Karin Dieckmann
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Ahmed Gawish
- Department of Radiotherapy, University Medical Center Giessen-Marburg, Marburg, Germany
| | - Sabine Gerum
- Department of Radiation Oncology, Paracelsus University Salzburg, Salzburg, Austria
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Stephanie-Tanadini Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Peter Winkler
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Brigitte Zurl
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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2
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Multi-organ segmentation of abdominal structures from non-contrast and contrast enhanced CT images. Sci Rep 2022; 12:19093. [PMID: 36351987 PMCID: PMC9646761 DOI: 10.1038/s41598-022-21206-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Manually delineating upper abdominal organs at risk (OARs) is a time-consuming task. To develop a deep-learning-based tool for accurate and robust auto-segmentation of these OARs, forty pancreatic cancer patients with contrast-enhanced breath-hold computed tomographic (CT) images were selected. We trained a three-dimensional (3D) U-Net ensemble that automatically segments all organ contours concurrently with the self-configuring nnU-Net framework. Our tool's performance was assessed on a held-out test set of 30 patients quantitatively. Five radiation oncologists from three different institutions assessed the performance of the tool using a 5-point Likert scale on an additional 75 randomly selected test patients. The mean (± std. dev.) Dice similarity coefficient values between the automatic segmentation and the ground truth on contrast-enhanced CT images were 0.80 ± 0.08, 0.89 ± 0.05, 0.90 ± 0.06, 0.92 ± 0.03, 0.96 ± 0.01, 0.97 ± 0.01, 0.96 ± 0.01, and 0.96 ± 0.01 for the duodenum, small bowel, large bowel, stomach, liver, spleen, right kidney, and left kidney, respectively. 89.3% (contrast-enhanced) and 85.3% (non-contrast-enhanced) of duodenum contours were scored as a 3 or above, which required only minor edits. More than 90% of the other organs' contours were scored as a 3 or above. Our tool achieved a high level of clinical acceptability with a small training dataset and provides accurate contours for treatment planning.
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3
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Liu Y, Wen T, Sun W, Liu Z, Song X, He X, Zhang S, Wu Z. Graph-Based Motion Artifacts Detection Method from Head Computed Tomography Images. SENSORS (BASEL, SWITZERLAND) 2022; 22:5666. [PMID: 35957222 PMCID: PMC9371218 DOI: 10.3390/s22155666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Computed tomography (CT) images play an important role due to effectiveness and accessibility, however, motion artifacts may obscure or simulate pathology and dramatically degrade the diagnosis accuracy. In recent years, convolutional neural networks (CNNs) have achieved state-of-the-art performance in medical imaging due to the powerful learning ability with the help of the advanced hardware technology. Unfortunately, CNNs have significant overhead on memory usage and computational resources and are labeled 'black-box' by scholars for their complex underlying structures. To this end, an interpretable graph-based method has been proposed for motion artifacts detection from head CT images in this paper. From a topological perspective, the artifacts detection problem has been reformulated as a complex network classification problem based on the network topological characteristics of the corresponding complex networks. A motion artifacts detection method based on complex networks (MADM-CN) has been proposed. Firstly, the graph of each CT image is constructed based on the theory of complex networks. Secondly, slice-to-slice relationship has been explored by multiple graph construction. In addition, network topological characteristics are investigated locally and globally, consistent topological characteristics including average degree, average clustering coefficient have been utilized for classification. The experimental results have demonstrated that the proposed MADM-CN has achieved better performance over conventional machine learning and deep learning methods on a real CT dataset, reaching up to 98% of the accuracy and 97% of the sensitivity.
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Affiliation(s)
- Yiwen Liu
- School of Computer Science and Engineering, Northeastern University, Shenyang 110819, China;
| | - Tao Wen
- School of Computer Science and Engineering, Northeastern University, Shenyang 110819, China;
- Department of Computer Science and Technology, Dalian Neusoft University of Information, Dalian 116023, China; (Z.L.); (X.S.)
| | - Wei Sun
- School of Computer Science, Neusoft Institute Guangdong, Foshan 528225, China;
| | - Zhenyu Liu
- Department of Computer Science and Technology, Dalian Neusoft University of Information, Dalian 116023, China; (Z.L.); (X.S.)
| | - Xiaoying Song
- Department of Computer Science and Technology, Dalian Neusoft University of Information, Dalian 116023, China; (Z.L.); (X.S.)
| | - Xuan He
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, China;
| | - Shuo Zhang
- School of Information Science and Engineering, Northeastern University, Shenyang 110819, China; (S.Z.); (Z.W.)
| | - Zhenning Wu
- School of Information Science and Engineering, Northeastern University, Shenyang 110819, China; (S.Z.); (Z.W.)
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4
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de Ridder M, Raaijmakers CPJ, Pameijer FA, de Bree R, Reinders FCJ, Doornaert PAH, Terhaard CHJ, Philippens MEP. Target Definition in MR-Guided Adaptive Radiotherapy for Head and Neck Cancer. Cancers (Basel) 2022; 14:3027. [PMID: 35740691 PMCID: PMC9220977 DOI: 10.3390/cancers14123027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, MRI-guided radiotherapy (MRgRT) has taken an increasingly important position in image-guided radiotherapy (IGRT). Magnetic resonance imaging (MRI) offers superior soft tissue contrast in anatomical imaging compared to computed tomography (CT), but also provides functional and dynamic information with selected sequences. Due to these benefits, in current clinical practice, MRI is already used for target delineation and response assessment in patients with head and neck squamous cell carcinoma (HNSCC). Because of the close proximity of target areas and radiosensitive organs at risk (OARs) during HNSCC treatment, MRgRT could provide a more accurate treatment in which OARs receive less radiation dose. With the introduction of several new radiotherapy techniques (i.e., adaptive MRgRT, proton therapy, adaptive cone beam computed tomography (CBCT) RT, (daily) adaptive radiotherapy ensures radiation dose is accurately delivered to the target areas. With the integration of a daily adaptive workflow, interfraction changes have become visible, which allows regular and fast adaptation of target areas. In proton therapy, adaptation is even more important in order to obtain high quality dosimetry, due to its susceptibility for density differences in relation to the range uncertainty of the protons. The question is which adaptations during radiotherapy treatment are oncology safe and at the same time provide better sparing of OARs. For an optimal use of all these new tools there is an urgent need for an update of the target definitions in case of adaptive treatment for HNSCC. This review will provide current state of evidence regarding adaptive target definition using MR during radiotherapy for HNSCC. Additionally, future perspectives for adaptive MR-guided radiotherapy will be discussed.
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Affiliation(s)
- Mischa de Ridder
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
| | - Cornelis P. J. Raaijmakers
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
| | - Frank A. Pameijer
- Department of Radiology, University Medical Center Utrecht, 3584 Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 Utrecht, The Netherlands;
| | - Floris C. J. Reinders
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
| | - Patricia A. H. Doornaert
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
| | - Chris H. J. Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
| | - Marielle E. P. Philippens
- Department of Radiotherapy, University Medical Center Utrecht, 3584 Utrecht, The Netherlands; (C.P.J.R.); (F.C.J.R.); (P.A.H.D.); (C.H.J.T.); (M.E.P.P.)
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5
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Rhee DJ, Akinfenwa CPA, Rigaud B, Jhingran A, Cardenas CE, Zhang L, Prajapati S, Kry SF, Brock KK, Beadle BM, Shaw W, O'Reilly F, Parkes J, Burger H, Fakie N, Trauernicht C, Simonds H, Court LE. Automatic contouring QA method using a deep learning-based autocontouring system. J Appl Clin Med Phys 2022; 23:e13647. [PMID: 35580067 PMCID: PMC9359039 DOI: 10.1002/acm2.13647] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/27/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose To determine the most accurate similarity metric when using an independent system to verify automatically generated contours. Methods A reference autocontouring system (primary system to create clinical contours) and a verification autocontouring system (secondary system to test the primary contours) were used to generate a pair of 6 female pelvic structures (UteroCervix [uterus + cervix], CTVn [nodal clinical target volume (CTV)], PAN [para‐aortic lymph nodes], bladder, rectum, and kidneys) on 49 CT scans from our institution and 38 from other institutions. Additionally, clinically acceptable and unacceptable contours were manually generated using the 49 internal CT scans. Eleven similarity metrics (volumetric Dice similarity coefficient (DSC), Hausdorff distance, 95% Hausdorff distance, mean surface distance, and surface DSC with tolerances from 1 to 10 mm) were calculated between the reference and the verification autocontours, and between the manually generated and the verification autocontours. A support vector machine (SVM) was used to determine the threshold that separates clinically acceptable and unacceptable contours for each structure. The 11 metrics were investigated individually and in certain combinations. Linear, radial basis function, sigmoid, and polynomial kernels were tested using the combinations of metrics as inputs for the SVM. Results The highest contouring error detection accuracies were 0.91 for the UteroCervix, 0.90 for the CTVn, 0.89 for the PAN, 0.92 for the bladder, 0.95 for the rectum, and 0.97 for the kidneys and were achieved using surface DSCs with a thickness of 1, 2, or 3 mm. The linear kernel was the most accurate and consistent when a combination of metrics was used as an input for the SVM. However, the best model accuracy from the combinations of metrics was not better than the best model accuracy from a surface DSC as an input. Conclusions We distinguished clinically acceptable contours from clinically unacceptable contours with an accuracy higher than 0.9 for the targets and critical structures in patients with cervical cancer; the most accurate similarity metric was surface DSC with a thickness of 1, 2, or 3 mm.
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Affiliation(s)
- Dong Joo Rhee
- The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, Texas, USA.,Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carlos E Cardenas
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lifei Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Surendra Prajapati
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen F Kry
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - William Shaw
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Frederika O'Reilly
- Department of Medical Physics (G68), University of the Free State, Bloemfontein, South Africa
| | - Jeannette Parkes
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hester Burger
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nazia Fakie
- Division of Radiation Oncology and Medical Physics, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Chris Trauernicht
- Division of Medical Physics, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Hannah Simonds
- Division of Radiation Oncology, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Laurence E Court
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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6
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Pawałowski B, Ryczkowski A, Panek R, Sobocka-Kurdyk U, Graczyk K, Piotrowski T. Accuracy of the doses computed by the Eclipse treatment planning system near and inside metal elements. Sci Rep 2022; 12:5974. [PMID: 35396569 PMCID: PMC8993896 DOI: 10.1038/s41598-022-10072-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
Metal artefacts degrade clinical image quality which decreases the confidence of using computed tomography (CT) for the delineation of key structures for treatment planning and leads to dose errors in affected areas. In this work, we investigated accuracy of doses computed by the Eclipse treatment planning system near and inside metallic elements for two different computation algorithms. An impact of CT metal artefact reduction methods on the resulting calculated doses has also been assessed. A water phantom including Gafchromic film and metal inserts was irradiated (max dose 5 Gy) using a 6 MV photon beam. Three materials were tested: titanium, alloy 600, and tungsten. The phantom CT images were obtained with the pseudo-monoenergetic reconstruction (PMR) and the iterative metal artefact reduction (iMAR). Image sets were used for dose calculation using an Eclipse treatment planning station (TPS). Monte Carlo (MC) simulations were used to predict the true dose distribution in the phantom allowing for comparison with doses measured by film and calculated by TPS. Measured and simulated percentage depth doses (PDDs) were not statistically different (p > 0.618). Regional differences were observed at edges of metallic objects (max 8% difference). However, PDDs simulated with and without film were statistically different (p < 0.002). PDDs calculated by the Acuros XB algorithm based on the dose-to-medium approach best matched the MC reference regardless of the CT reconstruction methods and inserts used (p > 0.078). PDDs obtained using other algorithms significantly differ from the MC values (p < 0.011). The Acuros XB algorithm with a dose-to-medium approach provides reliable dose calculation in all metal regions when using the Varian system. The inability of the AAA algorithm to model backscatter dose significantly limits its clinical application in the presence of metal. No significant impact on the dose calculation was found for a range of metal artefact reduction strategies.
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Affiliation(s)
- Bartosz Pawałowski
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866, Poznan, Poland.,Department of Technical Physics, Poznan University of Technology, Poznan, Poland
| | - Adam Ryczkowski
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866, Poznan, Poland.,Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Panek
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Urszula Sobocka-Kurdyk
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866, Poznan, Poland.,Faculty of Health Sciences, Calisia University, Kalisz, Poland
| | - Kinga Graczyk
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866, Poznan, Poland
| | - Tomasz Piotrowski
- Department of Medical Physics, Greater Poland Cancer Centre, Garbary 15, 61-866, Poznan, Poland. .,Department of Electroradiology, Poznan University of Medical Sciences, Poznan, Poland.
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7
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Cardenas CE, Blinde SE, Mohamed ASR, Ng SP, Raaijmakers C, Philippens M, Kotte A, Al-Mamgani AA, Karam I, Thomson DJ, Robbins J, Newbold K, Fuller CD, Terhaard C, On Behalf Of The, Bahig H, Blanchard P, Dehnad H, Doornaert P, Elhalawani H, Frank SJ, Garden A, Gunn GB, Hamming-Vrieze O, Kamal M, Kasperts N, Lee LW, McDonald BA, McPartlin A, Meheissen MA, Morrison WH, Navran A, Nutting CM, Pameijer F, Phan J, Poon I, Rosenthal DI, Smid EJ, Sykes AJ. Comprehensive Quantitative Evaluation of Variability in MR-guided Delineation of Oropharyngeal Gross Tumor Volumes and High-risk Clinical Target Volumes: An R-IDEAL Stage 0 Prospective Study. Int J Radiat Oncol Biol Phys 2022; 113:426-436. [PMID: 35124134 DOI: 10.1016/j.ijrobp.2022.01.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Tumor and target volume manual delineation remains a challenging task in head-and-neck cancer radiotherapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation MR scans of oropharyngeal cancer (OPC) patients. METHODS Pre-treatment T1-weighted (T1w), T1-weighted with gadolinium contrast (T1w+C) and T2-weighted (T2w) MRI scans were retrospectively collected for 4 OPC patients under an IRB-approved protocol. The scans were provided to twenty-six radiation oncologists from seven international cancer centers who participated in this delineation study. In addition, patients' clinical history and physical examination findings, along with a medical photographic image and radiological results, were provided. The contours were compared using overlap/distance metrics using both STAPLE and pair-wise comparisons. Lastly, participants completed a brief questionnaire to assess participants' experience and CTV delineation institutional practices. RESULTS Large variability was measured between observers' delineations for GTVs and CTVs. The mean Dice Similarity Coefficient values across all physicians' delineations for GTVp, GTVn, CTVp, and CTVn were 0.77, 0.67, 0.77, and 0.69, respectively, for STAPLE comparison and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap/distance metrics. The median radiation oncology clinical experience was 7 years. The median experience delineating on MRI was 3.5 years. The GTV-to-CTV margin used was 10 mm for six of seven participant institutions. One institution used 8 mm and three participants (from three different institutions) used a margin of 5 mm. CONCLUSION The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of MR-based treatment planning for head-and-neck cancers. Such efforts should play a critical role in reducing delineation variation and ensure standardization of target design across clinical practices.
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Affiliation(s)
- Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Sanne E Blinde
- Department of Radiation Oncology, Klinikum Kassel, Kassel, Germany
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Cornelis Raaijmakers
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle Philippens
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexis Kotte
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abrahim A Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jared Robbins
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Kate Newbold
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Chris Terhaard
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - On Behalf Of The
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Blanchard
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Homan Dehnad
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia Doornaert
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolien Kasperts
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lip Wai Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mohamed Am Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frank Pameijer
- Department of Radiology, Division of Imaging & Oncology, University Medical Center, Utrecht, The Netherlands
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ernst J Smid
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew J Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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