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Offersen BV, Aznar MC, Bacchus C, Coppes RP, Deutsch E, Georg D, Haustermans K, Hoskin P, Krause M, Lartigau EF, Lee AWM, Löck S, Thwaites DI, van der Kogel AJ, van der Heide U, Valentini V, Overgaard J, Baumann M. The role of ESTRO guidelines in achieving consistency and quality in clinical radiation oncology practice. Radiother Oncol 2023; 179:109446. [PMID: 36566990 DOI: 10.1016/j.radonc.2022.109446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, United Kingdom
| | - Carol Bacchus
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rob P Coppes
- Department of Biomedical Sciences of Cells & Systems, Section Molecular Cell Biology, Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eric Deutsch
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, France
| | - Dieter Georg
- Division Medical Radiation Physics, Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Peter Hoskin
- Mount Vernon Cancer Centre and University of Manchester, United Kingdom
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - Eric F Lartigau
- Academic Department of Radiotherapy, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Anne W M Lee
- Department of Clinical Oncology, Shenzhen Key Laboratory for Cancer Metastasis and Personalized Therapy, University of Hong Kong - Shenzhen Hospital, China
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Australia; Radiotherapy Research Group, St James's Hospital and University of Leeds, United Kingdom
| | - Albert J van der Kogel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Uulke van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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2
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Shen J, Zhang F, Di M, Shen J, Wang S, Chen Q, Chen Y, Liu Z, Lian X, Ma J, Pang T, Dong T, Wang B, Guan Q, He L, Zhang Y, Liang H. Clinical target volume automatic segmentation based on lymph node stations for lung cancer with bulky lump lymph nodes. Thorac Cancer 2022; 13:2897-2903. [PMID: 36085253 PMCID: PMC9575127 DOI: 10.1111/1759-7714.14638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background The lack of standardized delineation of lymph node station in lung cancer radiotherapy leads to nonstandard clinical target volume (CTV) contouring, especially in patients with bulky lump gross target volume lymph nodes (GTVnd). This study defines lymph node region boundaries in radiotherapy for lung cancer and automatically contours lymph node stations based on the International Association for the Study of Lung Cancer (IASLC) lymph node map. Methods Computed tomography (CT) scans of 200 patients with small cell lung cancer were collected. The lymph node zone boundaries were defined based on the IASLC lymph node map, with adjustments to meet radiotherapy requirements. Contours of lymph node stations were confirmed by two experienced oncologists. A model (DiUNet) was constructed by incorporating the contours of GTVnd to precisely contour the boundaries. Quantitative evaluation metrics and clinical evaluations were conducted. Results The mean 3D Dice similarity coefficient (Dice similarity coefficient) values of DiUNet in most lymph node stations was greater than 0.7, 98.87% of the lymph node station slices are accepted. The mean DiUNet score was not significantly different from that of the man contoured in the evaluation of lymph node stations and CTV. Conclusion This is the first study to propose a method that automatically contours lymph node regions station by station based on the IASLC lymph node map with bulky lump GTVnd. Delineation of lymph node stations based on the DiUNet model is a promising strategy to obtain accuracy and efficiency for CTV delineation in lung cancer patients, especially for bulky lump GTVnd.
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Affiliation(s)
- Jie Shen
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Mingyi Di
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Jing Shen
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | | | - Qi Chen
- MedMind Technology Co, Ltd., Beijing, China
| | - Yu Chen
- MedMind Technology Co, Ltd., Beijing, China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Jiabin Ma
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Tingtian Pang
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Tingting Dong
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Bei Wang
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Qiu Guan
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Lei He
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Yue Zhang
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
| | - Hao Liang
- Department of Radiation Oncology, Peking Union Medical College, Beijing, China
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Moilanen T, Sivonen M, Hipp K, Kallio H, Papinaho O, Stolt M, Turjamaa R, Häggman-Laitila A, Kangasniemi M. Developing a Feasible and Credible Method for Analyzing Healthcare Documents as Written Data. Glob Qual Nurs Res 2022; 9:23333936221108706. [PMID: 35832602 PMCID: PMC9272191 DOI: 10.1177/23333936221108706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
Healthcare provides a rich, and constantly increasing, number of written documents, which are underutilized in research data for health and nursing sciences, but previous literature has only provided limited guidance on the process of document analysis. The aim of this paper is to provide a methodological framework for analyzing health care documents as written data, based on a systematic methodological review and the research team’s experience of the method. Based on the results, the methods consist of seven phases: (i) identify the purpose, (ii) determine the document selection strategy, (iii) select or design an extraction matrix, (iv) carry out pilot testing, (v) collect and analyze the data, (vi) consider the credibility, and (vii) ethics of the study. The framework that has been developed can be used to carry out document analysis studies that are both feasible and credible.
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Affiliation(s)
| | - Mari Sivonen
- Karelia University of Applied Sciences, Joensuu, Finland
| | - Kirsi Hipp
- Häme University of Applied Sciences, Finland
| | | | - Oili Papinaho
- University of Turku, Finland.,Oulu University Hospital, Finland
| | | | | | - Arja Häggman-Laitila
- University of Eastern Finland, Kuopio, Finland.,Department of Social Services and Health Care, Helsinki, Finland
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Charlier F, Descamps T, Lievens Y, Geets X, Remouchamps V, Lambrecht M, Moretti L. ProCaLung - Peer review in stage III, mediastinal node-positive, non-small-cell lung cancer: How to benchmark clinical practice of nodal target volume definition and delineation in Belgium ☆. Radiother Oncol 2021; 167:57-64. [PMID: 34890738 DOI: 10.1016/j.radonc.2021.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The Quality Assurance project for stage III non-small cell lung cancer radiotherapy ProCaLung performed a multicentric two-step exercise evaluating mediastinal nodal Target Volume Definition and Delineation (TVD) variability and the opportunity for standardization. The TVD variability before and after providing detailed guidelines and the value of qualitative contour reviewing before applying quantitative measures were investigated. MATERIALS AND METHODS The case of a patient with stage III NSCLC and involved mediastinal lymph nodes was used as a basis for this study. Twenty-two radiation oncologists from nineteen centers in Belgium and Luxembourg participated in at least one of two phases of the project (before and after introduction of ProCaLung contouring guidelines). The resulting thirty-three mediastinal nodal GTV and CTV contours were then evaluated using a qualitative-before-quantitative (QBQ) approach. First, a qualitative analysis was performed, evaluating adherence to most recent guidelines. From this, a list of observed deviations was created and these were used to evaluate contour conformity. The second analysis was quantitative, using overlap and surface distance measures to compare contours within qualitative groups and between phases. A 'most robust' reference volume for these analyses was created using the STAPLE-algorithm and an averaging method. RESULTS Five GTV and seven CTV qualitative groups were identified. Second step contours were more often in higher-conformity groups (p = 0.012 for GTV and p = 0.024 for CTV). Median Residual Mean Square Distances improved from 2.34 mm to 1.36 mm for GTV (p = 0.01) and from 4.53 mm to 1.58 mm for CTV (p < 0.0001). Median Dice coefficients increased from 0.81 to 0.84 for GTV (p = 0.07) and from 0.82 to 0.89 for CTV (p ≤ 0.001). Using HC-contours only to generate references translated in more robust quantitative evaluations. CONCLUSION Variability of mediastinal nodal TVD was reduced after providing the ProCaLung consensus guidelines. A qualitative review was essential for providing meaningful quantitative measures.
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Affiliation(s)
- Florian Charlier
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Descamps
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Xavier Geets
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincent Remouchamps
- Radiation Oncology Department, CHU UCL Namur - site Sainte Elisabeth, Namur, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - Luigi Moretti
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Couto JG, McFadden S, McClure P, Bezzina P, Beardmore C, Hughes C. Competency level in radiotherapy across EU educational programmes: A cross-case study evaluating stakeholders' perceptions. Radiography (Lond) 2021; 28:180-186. [PMID: 34728137 DOI: 10.1016/j.radi.2021.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The education of Therapeutic Radiographers (TRs) is regulated in some countries but is not standardised across the EU, leading to differences in competencies between and within member states. This study aimed to explore stakeholders' perceptions regarding underdeveloped competencies of TRs practising on the linear accelerator, identified in a previous study by the same research team. METHODS Interviews with stakeholders from four countries (selected based on the characteristics of their degrees) were performed as part of this cross-case study. Stakeholders were asked to provide their perception regarding the least developed competencies identified in a previous study. RESULTS The 27 stakeholders confirmed that Pharmacology, Quality Assurance (QA), Management and Leadership, Research (from the previous study) were underdeveloped and identified Image Verification and Critical Thinking as additional underdeveloped competencies. Suggested causes included: lack of regulation of required competencies at the national level, lack of training dedicated to radiotherapy (RT) (taught within generic modules) and lack of time within the degree programme. The ideal academic level to develop these competencies and whether they are essential varied between country and stakeholder. CONCLUSION It is essential to regulate learning outcomes at the national level to ensure a high level of care is provided to all RT patients and, ideally, standardise it across Europe. Education institutions should review their curricula to ensure that sufficient time is dedicated to RT and that the essential competencies are developed. Due to time constraints within some programmes, some competencies must be developed after graduation. IMPLICATIONS FOR PRACTICE Lack of regulation of learning outcomes (at European level and national level in many countries) and lack of RT-specific training lead to underdeveloped competencies that may compromise patient care.
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Affiliation(s)
- J G Couto
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida, MSD2080, Malta.
| | - S McFadden
- School of Health Sciences, Ulster University, Newtownabbey, Co. Antrim, BT37 0QB, Ireland.
| | - P McClure
- School of Health Sciences, Ulster University, Newtownabbey, Co. Antrim, BT37 0QB, Ireland.
| | - P Bezzina
- Radiography Department, Faculty of Health Sciences, University of Malta, Msida, MSD2080, Malta.
| | - C Beardmore
- Society and College of Radiographers, London, UK; European Federation of Radiography Societies, Lievegem, Belgium.
| | - C Hughes
- School of Health Sciences, Ulster University, Newtownabbey, Co. Antrim, BT37 0QB, Ireland.
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6
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Marcuse F, Peeters S, Herman K, Vaassen F, van Elmpt W, Maat APWM, Praag J, Billiet C, Van Schil P, Lambrecht M, Van Raemdonck D, Cao K, Grigoroiu M, Girard N, Hochstenbag M, Maessen J, De Ruysscher D. Optimal delineation of the clinical target volume for thymomas in the post-resection setting: A multi-center study. Radiother Oncol 2021; 165:8-13. [PMID: 34673091 DOI: 10.1016/j.radonc.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/29/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The definition of the clinical target volume (CTV) for post-operative radiotherapy (PORT) for thymoma is largely unexplored. The aim of this study was to analyze the difference in CTV delineation between radiation oncologists (RTO) and surgeons. METHODS This retrospective multi-center study enrolled 31 patients who underwent PORT for a thymoma from five hospitals. Three CTVs were delineated per patient: one CTV by the RTO, one CTV by the surgeon (blinded to the results of the RTO) and a joint CTV after collaboration. Volumes (cm3), Hausdorff distances (HD) and Dice similarity coefficients (DSC) were analyzed. RESULTS RTO delineated significantly bigger CTVs than surgeons (mean: 93.9 ± 63.1, versus 57.9 ± 61.3 cm3, p = 0.003). Agreement was poor between RO and surgeons, with a low mean DSC (0.34 ± 0.21) and high mean HD of 4.5 (±2.2) cm. Collaborative delineation resulted in significantly smaller volumes compared to RTO (mean 57.1 ± 58.6 cm3, p < 0.001). A mean volume of 18.9 (±38.1) cm3 was included in joint contours, but missed by RTO. Conversely, a mean volume of 55.7 (±39.9) cm3 was included in RTO's delineations, but not in the joint delineations. CONCLUSIONS To the best of our knowledge, this is the first study investigating CTV definition in thymoma. We demonstrated a significant variability between RTO and surgeons. Joint delineation prompted revisions in smaller CTV as well as favoring the surgeons' judgement, suggesting that surgeons provided relevant insight into other risk areas than RTO. We recommend a multidisciplinary approach to PORT for thymomas in clinical practice.
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Affiliation(s)
- Florit Marcuse
- Department of Pulmonology, Maastricht University Medical Center+, the Netherlands.
| | - Stephanie Peeters
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, the Netherlands
| | - Kato Herman
- Department of Pulmonology, Maastricht University Medical Center+, the Netherlands
| | - Femke Vaassen
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, the Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, the Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - John Praag
- Department of Radiation Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, University of Antwerp, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven/KU Leuven, Belgium
| | - Kim Cao
- Department of Radiation Oncology, L'Institut du Thorax Curie-Montsouris, Paris, France
| | - Madalina Grigoroiu
- Department of Thoracic Surgery, L'Institut du Thorax Curie-Montsouris, Paris, France
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; UVSQ, Paris Saclay, Versailles, France
| | - Monique Hochstenbag
- Department of Pulmonology, Maastricht University Medical Center+, the Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, the Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, the Netherlands
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Mul J, Melchior P, Seravalli E, Saunders D, Bolle S, Cameron AL, Gurtner K, Harrabi S, Lassen-Ramshad Y, Lavan N, Magelssen H, Mandeville H, Boterberg T, Kroon PS, Kotte AN, Hoeben BA, van Rossum PS, van Grotel M, Graf N, van den Heuvel-Eibrink MM, Rübe C, Janssens GO. Inter-clinician delineation variation for a new highly-conformal flank target volume in children with renal tumors: A SIOP-Renal Tumor Study Group international multicenter exercise. Clin Transl Radiat Oncol 2021; 28:39-47. [PMID: 33796796 PMCID: PMC7995478 DOI: 10.1016/j.ctro.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Recently, the SIOP-RTSG developed a highly-conformal flank target volume definition for children with renal tumors. The aims of this study were to evaluate the inter-clinician delineation variation of this new target volume definition in an international multicenter setting and to explore the necessity of quality assurance. MATERIALS AND METHODS Six pediatric renal cancer cases were transferred to ten radiation oncologists from seven European countries ('participants'). These participants delineated the pre- and postoperative Gross Tumor Volume (GTVpre/post), and Clinical Target Volume (CTV) during two test phases (case 1-2 and 3-4), followed by guideline refinement and a quality assurance phase (case 5-6). Reference target volumes (TVref) were established by three experienced radiation oncologists. The Dice Similarity Coefficient between the reference and participants (DSCref/part) was calculated per case. Delineations of case 5-6 were graded by four independent reviewers as 'per protocol' (0-4 mm), 'minor deviation' (5-9 mm) or 'major deviation' (≥10 mm) from the delineation guideline using 18 standardized criteria. Also, a major deviation resulting in underestimation of the CTVref was regarded as an unacceptable variation. RESULTS A total of 57/60 delineation sets were completed. The median DSCref/part for the CTV was 0.55 without improvement after sequential cases (case 3-4 vs. case 5-6: p = 0.15). For case 5-6, a major deviation was found for 5/18, 12/17, 18/18 and 4/9 collected delineations of the GTVpre, GTVpost, CTV-T and CTV-N, respectively. An unacceptable variation from the CTVref was found for 7/9 participants for case 5 and 6/9 participants for case 6. CONCLUSION This international multicenter delineation exercise demonstrates that the new consensus for highly-conformal postoperative flank target volume delineation leads to geometrical variation among participants. Moreover, standardized review showed an unacceptable delineation variation in the majority of the participants. These findings strongly suggest the need for additional training and centralized pre-treatment review when this target volume delineation approach is implemented on a larger scale.
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Key Words
- AA, abdominal aorta
- AP/PA, Anterior-Posterior/Posterior-Anterior
- CT, Computed Tomography
- CTV-N, Clinical Target Volume of the lymph node area
- CTV-T, Clinical Target Volume of the primary Tumor
- DICOM, Digital Imaging and Communications in Medicine
- DSC, Dice Similarity Coefficient
- Flank target volume
- GTVpre/post, pre- and postoperative Gross Tumor Volume respectively
- HR, High-Risk
- Highly-conformal radiotherapy
- IGRT, Image-Guided Radiotherapy
- IMRT, Intensity-Modulated Radiotherapy
- IR, Intermediate-Risk
- IVC, inferior vena cava
- Inter-clinician variation
- MRI, Magnetic Resonance Imaging
- OAR, organs at risk
- Pediatric renal tumors
- Quality assurance
- RT, radiotherapy
- RTOG, Radiation Oncology Group
- RTSG, Renal Tumor Study Group
- SIOP, International Society for Pediatric Oncology
- TVintersect, intersect target volume
- TVref, reference target volumes
- WT, Wilms’ tumor
- Wilms tumor
- n.a., not applicable
- part, participant
- ref, reference
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Affiliation(s)
- Joeri Mul
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Patrick Melchior
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniel Saunders
- Dept. of Clinical Oncology, The Christie Hospital, Manchester, United Kingdom
| | - Stephanie Bolle
- Dept. of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Alison L. Cameron
- Bristol Cancer Institute, University Hospitals, Bristol, United Kingdom
| | - Kristin Gurtner
- Dept. of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Semi Harrabi
- Dept. of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Naomi Lavan
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | - Henry Mandeville
- Dept. of Clinical Oncology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Tom Boterberg
- Dept. of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexis N.T.J. Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bianca A.W. Hoeben
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S.N. van Rossum
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Norbert Graf
- Dept. of Pediatric Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Christian Rübe
- Dept. of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Mercieca S, Belderbos JSA, van Herk M. Challenges in the target volume definition of lung cancer radiotherapy. Transl Lung Cancer Res 2021; 10:1983-1998. [PMID: 34012808 PMCID: PMC8107734 DOI: 10.21037/tlcr-20-627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Radiotherapy, with or without systemic treatment has an important role in the management of lung cancer. In order to deliver the treatment accurately, the clinician must precisely outline the gross tumour volume (GTV), mostly on computed tomography (CT) images. However, due to the limited contrast between tumour and non-malignant changes in the lung tissue, it can be difficult to distinguish the tumour boundaries on CT images leading to large interobserver variation and differences in interpretation. Therefore the definition of the GTV has often been described as the weakest link in radiotherapy with its inaccuracy potentially leading to missing the tumour or unnecessarily irradiating normal tissue. In this article, we review the various techniques that can be used to reduce delineation uncertainties in lung cancer.
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Affiliation(s)
- Susan Mercieca
- Faculty of Health Science, University of Malta, Msida, Malta.,The University of Amsterdam, Amsterdam, The Netherlands
| | - José S A Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel van Herk
- University of Manchester, Manchester Academic Health Centre, The Christie NHS Foundation Trust, Manchester, UK
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[Diffusion-weighted imaging-diagnostic supplement or alternative to contrast agents in early detection of malignancies?]. Radiologe 2019; 59:517-522. [PMID: 31065738 DOI: 10.1007/s00117-019-0532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Medical research in the field of oncologic imaging diagnostics using magnetic resonance imaging increasingly includes diffusion-weighted imaging (DWI) sequences. The DWI sequences allow insights into different microstructural diffusion properties of water molecules in tissues depending on the sequence modification used and enable visual and quantitative analysis of the acquired imaging data. In DWI, the application of intravenous gadolinium-containing contrast agents is unnecessary and only the mobility of naturally occurring water molecules in tissues is quantified. These characteristics predispose DWI as a potential candidate for emerging as an independent diagnostic tool in selected cases and specific points in question. Current clinical diagnostic studies and the ongoing technical developments, including the increasing influence of artificial intelligence in radiology, support the growing importance of DWI. Especially with respect to selective approaches for early detection of malignancies, DWI could make an essential contribution as an eligible diagnostic tool; however, prior to discussing a broader clinical implementation, challenges regarding reliable data quality, standardization and quality assurance must be overcome.
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Elhalawani H, Elgohari B, Lin TA, Mohamed ASR, Fitzgerald TJ, Laurie F, Ulin K, Kalpathy-Cramer J, Guerrero T, Holliday EB, Russo G, Patel A, Jones W, Walker GV, Awan M, Choi M, Dagan R, Mahmoud O, Shapiro A, Kong FMS, Gomez D, Zeng J, Decker R, Spoelstra FOB, Gaspar LE, Kachnic LA, Thomas CR, Okunieff P, Fuller CD. An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting. Clin Transl Radiat Oncol 2019; 15:83-92. [PMID: 30775563 PMCID: PMC6365802 DOI: 10.1016/j.ctro.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
We aimed at quantifying inter-observer Pancoast tumors delineation variability. Experts’ delineations were used to define ground truth. Other observers’ delineations were compared against ground truth. High degree of variability was noted for most target volumes except GTV_P. This unveils potentials for protocol modification for future IMRT studies.
Introduction Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee’s multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.
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Affiliation(s)
- Hesham Elhalawani
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Baher Elgohari
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Timothy A Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Baylor College of Medicine, TX 77030, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Thomas J Fitzgerald
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Fran Laurie
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Massachusetts, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Emma B Holliday
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Gregory Russo
- Department of Radiation Oncology, Boston Medical Center, Massachusetts, USA
| | - Abhilasha Patel
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - William Jones
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - Gary V Walker
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Musaddiq Awan
- Department of Radiation Oncology, Case Western Reserve University, OH, USA
| | - Mehee Choi
- Department of Radiation Oncology, Northwestern University, IL, USA
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, FL, USA
| | - Omar Mahmoud
- Department of Radiation Oncology, University of Miami, FL, USA
| | - Anna Shapiro
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, NY, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, OH, USA
| | - Daniel Gomez
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington Medical Center, WA, USA
| | - Roy Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, Connecticut, USA
| | - Femke O B Spoelstra
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laurie E Gaspar
- Department of Radiation Oncology, Vanderbilt University, TN, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Vanderbilt University Medical Center, Tennessee, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Oregon, USA
| | - Paul Okunieff
- SWOG, Department of Radiation Oncology, University of Florida College of Medicine, Florida, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
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