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Miles E, Wadsley J, Diez P, Patel R, Gwynne S. The National Radiotherapy Trials Quality Assurance Group - Driving up Quality in Clinical Research and Clinical Care. Clin Oncol (R Coll Radiol) 2024; 36:273-277. [PMID: 38360487 DOI: 10.1016/j.clon.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Affiliation(s)
- E Miles
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, UK; Mount Vernon Cancer Centre, Northwood, UK.
| | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | - P Diez
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - R Patel
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, UK; Mount Vernon Cancer Centre, Northwood, UK
| | - S Gwynne
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, UK; South West Wales Cancer Centre, Swansea, UK; Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
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Walter A, Hoegen-Saßmannshausen P, Stanic G, Rodrigues JP, Adeberg S, Jäkel O, Frank M, Giske K. Segmentation of 71 Anatomical Structures Necessary for the Evaluation of Guideline-Conforming Clinical Target Volumes in Head and Neck Cancers. Cancers (Basel) 2024; 16:415. [PMID: 38254904 PMCID: PMC11154560 DOI: 10.3390/cancers16020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The delineation of the clinical target volumes (CTVs) for radiation therapy is time-consuming, requires intensive training and shows high inter-observer variability. Supervised deep-learning methods depend heavily on consistent training data; thus, State-of-the-Art research focuses on making CTV labels more homogeneous and strictly bounding them to current standards. International consensus expert guidelines standardize CTV delineation by conditioning the extension of the clinical target volume on the surrounding anatomical structures. Training strategies that directly follow the construction rules given in the expert guidelines or the possibility of quantifying the conformance of manually drawn contours to the guidelines are still missing. Seventy-one anatomical structures that are relevant to CTV delineation in head- and neck-cancer patients, according to the expert guidelines, were segmented on 104 computed tomography scans, to assess the possibility of automating their segmentation by State-of-the-Art deep learning methods. All 71 anatomical structures were subdivided into three subsets of non-overlapping structures, and a 3D nnU-Net model with five-fold cross-validation was trained for each subset, to automatically segment the structures on planning computed tomography scans. We report the DICE, Hausdorff distance and surface DICE for 71 + 5 anatomical structures, for most of which no previous segmentation accuracies have been reported. For those structures for which prediction values have been reported, our segmentation accuracy matched or exceeded the reported values. The predictions from our models were always better than those predicted by the TotalSegmentator. The sDICE with 2 mm margin was larger than 80% for almost all the structures. Individual structures with decreased segmentation accuracy are analyzed and discussed with respect to their impact on the CTV delineation following the expert guidelines. No deviation is expected to affect the rule-based automation of the CTV delineation.
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Affiliation(s)
- Alexandra Walter
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Karlsruhe Institute of Technology (KIT), Scientific Computing Center, Zirkel 2, 76131 Karlsruhe, Germany;
| | - Philipp Hoegen-Saßmannshausen
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, 69120 Heidelberg, Germany
| | - Goran Stanic
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Faculty of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Joao Pedro Rodrigues
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
| | - Sebastian Adeberg
- Department of Radiotherapy and Radiation Oncology, Marburg University Hospital, 35043 Marburg, Germany;
- Marburg Ion-Beam Therapy Center (MIT), 35043 Marburg, Germany
- Universitäres Centrum für Tumorerkrankungen (UCT), 35033 Marburg, Germany
| | - Oliver Jäkel
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
- Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
| | - Martin Frank
- Karlsruhe Institute of Technology (KIT), Scientific Computing Center, Zirkel 2, 76131 Karlsruhe, Germany;
| | - Kristina Giske
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (G.S.); (J.P.R.); (O.J.); (K.G.)
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), 69120 Heidelberg, Germany;
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Evaluation of the impact of teaching on delineation variation during a virtual stereotactic ablative radiotherapy contouring workshop. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Introduction:
Variation in delineation of target volumes/organs at risk (OARs) is well recognised in radiotherapy and may be reduced by several methods including teaching. We evaluated the impact of teaching on contouring variation for thoracic/pelvic stereotactic ablative radiotherapy (SABR) during a virtual contouring workshop.
Materials and methods:
Target volume/OAR contours produced by workshop participants for three cases were evaluated against reference contours using DICE similarity coefficient (DSC) and line domain error (LDE) metrics. Pre- and post-workshop DSC results were compared using Wilcoxon signed ranks test to determine the impact of teaching during the workshop.
Results:
Of 50 workshop participants, paired pre- and post-workshop contours were available for 21 (42%), 20 (40%) and 22 (44%) participants for primary lung cancer, pelvic bone metastasis and pelvic node metastasis cases, respectively. Statistically significant improvements post-workshop in median DSC and LDE results were observed for 6 (50%) and 7 (58%) of 12 structures, respectively, although the magnitude of DSC/LDE improvement was modest in most cases. An increase in median DSC post-workshop ≥0·05 was only observed for GTVbone, IGTVlung and SacralPlex, and reduction in median LDE > 1 mm was only observed for GTVbone, CTVbone and SacralPlex. Post-workshop, median DSC values were >0·7 for 75% of structures. For 92% of the structures, post-workshop contours were considered to be acceptable or within acceptable variation following review by the workshop faculty.
Conclusions:
This study has demonstrated that virtual SABR contouring training is feasible and was associated with some improvements in contouring variation for multiple target volumes/OARs.
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