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Open Access 01-12-2012 | Research

3D Variation in delineation of head and neck organs at risk

Authors: Charlotte L Brouwer, Roel JHM Steenbakkers, Edwin van den Heuvel, Joop C Duppen, Arash Navran, Henk P Bijl, Olga Chouvalova, Fred R Burlage, Harm Meertens, Johannes A Langendijk, Aart A van 't Veld

Published in: Radiation Oncology | Issue 1/2012

Abstract

Background

Consistent delineation of patient anatomy becomes increasingly important with the growing use of highly conformal and adaptive radiotherapy techniques. This study investigates the magnitude and 3D localization of interobserver variability of organs at risk (OARs) in the head and neck area with application of delineation guidelines, to establish measures to reduce current redundant variability in delineation practice.

Methods

Interobserver variability among five experienced radiation oncologists was studied in a set of 12 head and neck patient CT scans for the spinal cord, parotid and submandibular glands, thyroid cartilage, and glottic larynx. For all OARs, three endpoints were calculated: the Intraclass Correlation Coefficient (ICC), the Concordance Index (CI) and a 3D measure of variation (3D SD).

Results

All endpoints showed largest interobserver variability for the glottic larynx (ICC = 0.27, mean CI = 0.37 and 3D SD = 3.9 mm). Better agreement in delineations was observed for the other OARs (range, ICC = 0.32-0.83, mean CI = 0.64-0.71 and 3D SD = 0.9-2.6 mm). Cranial, caudal, and medial regions of the OARs showed largest variations. All endpoints provided support for improvement of delineation practice.

Conclusions

Variation in delineation is traced to several regional causes. Measures to reduce this variation can be: (1) guideline development, (2) joint delineation review sessions and (3) application of multimodality imaging. Improvement of delineation practice is needed to standardize patient treatments.

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Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D: Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol 2010, 28: 2996-3001. 10.1200/JCO.2009.27.4498CrossRefPubMed

Dirix P, Nuyts S: Evidence-based organ-sparing radiotherapy in head and neck cancer. Lancet Oncol 2010, 11: 85-91. 10.1016/S1470-2045(09)70231-1CrossRefPubMed

Nelms BE, Tomé WA, Robinson G, Wheeler J: Variations in the contouring of organs at risk: test case from a patient with oropharyngeal cancer. Int J Radiat Oncol Biol Phys, in press.

Bortfeld T, Jeraj R: The physical basis and future of radiation therapy. Br J Radiol 2011, 84: 485-498. 10.1259/bjr/86221320PubMedCentralCrossRefPubMed

Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A: Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010, 76: S58-S63. 10.1016/j.ijrobp.2009.06.090PubMedCentralCrossRefPubMed

Rasch C, Eisbruch A, Remeijer P, Bos L, Hoogeman M, van Herk M, Lebesque J: Irradiation of paranasal sinus tumors, a delineation and dose comparison study. Int J Radiat Oncol Biol Phys 2002, 52: 120-127. 10.1016/S0360-3016(01)01751-5CrossRefPubMed

van de Water TA, Bijl HP, Westerlaan HE, Langendijk JA: Delineation guidelines for organs at risk involved in radiation-induced salivary dysfunction and xerostomia. Radiother Oncol 2009, 93: 545-552. 10.1016/j.radonc.2009.09.008CrossRefPubMed

Christianen MEMC, Langendijk JA, Westerlaan HE, van de Water TA, Bijl HP: Delineation of organs at risk involved in swallowing for radiotherapy treatment planning. Radiother Oncol 2011, 101: 394-402. 10.1016/j.radonc.2011.05.015CrossRefPubMed

Qazi AA, Pekar V, Kim J, Xie J, Breen SL, Jaffray DA: Auto-segmentation of normal and target structures in head and neck CT images: a feature-driven model-based approach. Med Phys 2011, 38: 6160-6170. 10.1118/1.3654160CrossRefPubMed

10.

Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979, 86: 420-428.CrossRefPubMed

11.

Barnhart HX, Haber MJ, Lin LI: An overview on assessing agreement with continuous measurements. J Biopharm Stat 2007, 17: 529-569. 10.1080/10543400701376480CrossRefPubMed

12.

Shrout PE: Measurement reliability and agreement in psychiatry. Stat Methods Med Res 1998, 7: 301-317. 10.1191/096228098672090967CrossRefPubMed

13.

Kouwenhoven E: Measuring the similarity of target volume delineations independent of the number of observers. Phys Med Biol 2009, 54: 2863. 10.1088/0031-9155/54/9/018CrossRefPubMed

14.

Hanna GG, Hounsell AR, O'Sullivan JM: Geometrical analysis of radiotherapy target volume delineation: a systematic review of reported comparison methods. Clin Oncol 2010, 22: 515-525. 10.1016/j.clon.2010.05.006CrossRef

15.

Jameson MG, Holloway LC, Vial PJ, Vinod SK, Metcalfe PE: A review of methods of analysis in contouring studies for radiation oncology. J Med Imaging Radiat Oncol 2010, 54: 401-410. 10.1111/j.1754-9485.2010.02192.xCrossRefPubMed

16.

Deurloo K, Steenbakkers R, Zijp L, de Bois J, Nowak P, Rasch C, van Herk M: Quantification of shape variation of prostate and seminal vesicles during external beam radiotherapy. Int J Radiat Oncol Biol Phys 2005, 61: 228-238. 10.1016/j.ijrobp.2004.09.023CrossRefPubMed

17.

Steenbakkers R, Duppen J, Fitton I, Deurloo K, Zijp L, Uitterhoeve A, Rodrigus P, Kramer G, Bussink J, Jaeger K, et al.: Observer variation in target volume delineation of lung cancer related to radiation oncologist-computer interaction: a 'Big Brother' evaluation. Radiother Oncol 2005, 77: 182-190. 10.1016/j.radonc.2005.09.017CrossRefPubMed

18.

Yi SK, Hall WH, Mathai M, Dublin AB, Gupta V, Purdy JA, Chen AM: Validating the RTOG-endorsed brachial plexus contouring atlas: an evaluation of reproducibility among patients treated by intensity-modulated radiotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2012, 82: 1060-1064. 10.1016/j.ijrobp.2010.10.035CrossRefPubMed

19.

Geets X, Daisne J, Arcangeli S, Coche E, Poel M, Duprez T, Nardella G, Grégoire V: Inter-observer variability in the delineation of pharyngo-laryngeal tumor, parotid glands and cervical spinal cord: Comparison between CT-scan and MRI. Radiother Oncol 2005, 77: 25-31. 10.1016/j.radonc.2005.04.010CrossRefPubMed

20.

Rasch CR, Steenbakkers RJ, Fitton I, Duppen JC, Nowak PJ, Pameijer FA, Eisbruch A, Kaanders JH, Paulsen F, van Herk M: Decreased 3D observer variation with matched CT-MRI, for target delineation in Nasopharynx cancer. Radiat Oncol 2010, 5: 21. 10.1186/1748-717X-5-21PubMedCentralCrossRefPubMed

21.

Chao KSC, Bhide S, Chen H, Asper J, Bush S, Franklin G, Kavadi V, Liengswangwong V, Gordon W, Raben A, et al.: Reduce in variation and improve efficiency of target volume delineation by a computer-assisted system using a deformable image registration approach. Int J Radiat Oncol Biol Phys 2007, 68: 1512-1521. 10.1016/j.ijrobp.2007.04.037CrossRefPubMed

22.

Teguh D, Levendag P, Voet P, Al Mamgani A, Han X, Wolf T, Hibbard L, Nowak P, Akhiat H, Dirkx M, et al.: Clinical validation of atlas-based auto-segmentation of multiple target volumes and normal tissue (Swallowing/Mastication) structures in the head and neck. Int J Radiat Oncol Biol Phys 2011, 81: 950-957. 10.1016/j.ijrobp.2010.07.009CrossRefPubMed

Title: 3D Variation in delineation of head and neck organs at risk
Authors: Charlotte L Brouwer
Roel JHM Steenbakkers
Edwin van den Heuvel
Joop C Duppen
Arash Navran
Henk P Bijl
Olga Chouvalova
Fred R Burlage
Harm Meertens
Johannes A Langendijk
Aart A van 't Veld
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-7-32

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

3D Variation in delineation of head and neck organs at risk

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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