Uncertainties in volume delineation in radiation oncology: A systematic review and recommendations for future studies

Purpose: To assess the need for gross tumor volume (GTV) delineation protocols in head-and-neck cancer (HNC) treatment planning by use of positron emission tomography (PET)/computed tomography (CT) fusion imaging. Assessment will consist of interobserver and intermodality variation analysis. Methods and Materials: Sixteen HNC patients were accrued for the study. Four physicians (2 neuroradiologists and 2 radiation oncologists) contoured GTV on 16 patients. Physicians were asked to contour GTV on the basis of the CT alone, and then on PET/CT fusion. Statistical analysis included analysis of variance for interobserver variability and Student's paired sample t test for intermodality and interdisciplinary variability. A Boolean pairwise analysis was included to measure degree of overlap. Results: Near-significant variation occurred across physicians' CT volumes ( p = 0.09) and significant variation occurred across physicians' PET/CT volumes ( p = 0.0002). The Boolean comparison correlates with statistical findings. One radiation oncologist's PET/CT fusion volumes were significantly larger than his CT volumes ( p p = 0.06). No significant interdisciplinary variation was seen. Significant disagreement occurred between radiation oncologists. Conclusion: Significant differences in GTV delineation were found between multiple observers contouring on PET/CT fusion. The need for delineation protocol has been confirmed.

Variability of gross tumor volume delineation in head-and-neck cancer using CT and PET/CT fusion.

Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in the accuracy of target delineation in MRI-guided radiation therapy may improve clinical outcomes in a variety of cancer types. However, some considerations should be recognized including patient motion during image acquisition and geometric accuracy of images. Moreover, MR-compatible immobilization devices need to be used when acquiring images in the treatment position while minimizing patient motion during the scan time. Finally, synthetic CT images (i.e. electron density maps) and digitally reconstructed radiograph images should be generated from MRI images for dose calculation and image guidance prior to treatment. A short review of the concepts and techniques that have been developed for implementation of MRI-only workflows in radiation therapy is provided in this document.

/pdf/mri-only-treatment-planning-benefits-and-challenges-3dmiyad86v.pdf

MRI-only treatment planning: benefits and challenges

Inter-observer variability in the delineation of pharyngo-laryngeal tumor, parotid glands and cervical spinal cord: Comparison between CT-scan and MRI

Introduction

Inter-observer variability (IOV) in target volume and organ-at-risk (OAR) delineation is a source of potential error in radiation therapy treatment The aims of this study were to identify interventions shown to reduce IOV in volume delineation



Methods

Medline and Pubmed databases were queried for relevant articles using various keywords to identify articles which evaluated IOV in target or OAR delineation for multiple (>2) observers The search was limited to English language articles and to those published from 1 January 2000 to 31 December 2014 Reference lists of identified articles were scrutinised to identify relevant studies Studies were included if they reported IOV in contouring before and after an intervention including the use of additional or alternative imaging



Results

Fifty-six studies were identified These were grouped into evaluation of guidelines (n = 9), teaching (n = 9), provision of an autocontour (n = 7) and the impact of imaging (n = 31) on IOV Guidelines significantly reduced IOV in 7/9 studies Teaching interventions reduced IOV in 8/9 studies, statistically significant in 4 The provision of an autocontour improved consistency of contouring in 6/7 studies, statistically significant in 5 The effect of additional imaging on IOV was variable Pre-operative CT was useful in reducing IOV in contouring breast and liver cancers, PET scans in lung cancer, rectal cancer and lymphoma and MRI scans in OARs in head and neck cancers



Conclusion

Inter-observer variability in volume delineation can be reduced with the use of guidelines, provision of autocontours and teaching The use of multimodality imaging is useful in certain tumour sites

A review of interventions to reduce inter-observer variability in volume delineation in radiation oncology

Conformal radiotherapy planning of cervix carcinoma: differences in the delineation of the clinical target volume. A comparison between gynaecologic and radiation oncologists.

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Conformal radiotherapy planning of cervix carcinoma: differences in the delineation of the clinical target volume. A comparison between gynaecologic and radiation oncologists.