Impact of Peer Review in Reducing Uncertainty in the Definition of the Lung Target Volume Among Trainee Oncologists

Mercieca, Susan; Pan, S.; Belderbos, J.; Salem, Ahmed; Tenant, Sean; Aznar, Marianne C.; Woolf, David; Radhakrishna, Ganesh; Herk, Marcel van

doi:10.1016/j.clon.2020.01.026

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…Peer review of targets has demonstrated to increase contour agreement in radiation oncology. 22 Potentially, by discussing and delineating cases with cardiologist-electrophysiologists (or in multi-disciplinary teams) a reduction in interobserver variability could be achieved as well.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Variability in Target Definition for Stereotactic Arrhythmia Radioablation

Ree

Cuculich

Herk

et al. 2023

Preprint

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BackgroundStereotactic arrhythmia radioablation (STAR) is emerging as a potential new therapy for patients with refractory ventricular tachycardia (VT). The arrhythmogenic substrate (target) is synthesized from clinical and electro-anatomical information. This study was designed to evaluate the baseline interobserver variability in target delineation for STAR.MethodsDelineation software designed for research purposes was used. The study was split into three phases. Firstly, electrophysiologists (observers) delineated a well-defined structure in three patients (spinal canal). Secondly, observers delineated the arrhythmogenic cardiac VT target in three patients previously treated with STAR based on case descriptions. To evaluate baseline performance, a basic workflow approach was used, no advanced techniques were allowed (e.g. image integration). Thirdly, observers delineated three predefined segments from the cardiac 17-segment model. Interobserver variability was evaluated by assessing volumes, variation in distance to the median volume as expressed by the root-mean-square of the observer standard deviation (RMS SD) over the target volume, and the Dice coefficient.ResultsTen electrophysiologists completed the study. For the first phase (spinal canal delineation), interobserver variability was low as indicated by low variation in distance to the median volume (RMS SD range: 0.02-0.02cm) and high Dice coefficients (mean: 0.97±0.01). In the second phase (VT-target delineation), distance to the median volume was large (RMS SD range: 0.52-1.02cm) and the Dice coefficients low (mean: 0.40±0.15). In the third phase (segment delineation), similar results were observed (RMS SD range: 0.51-1.55cm, Dice coefficient mean: 0.31±0.21)ConclusionsInterobserver variability is high for manual delineation of the VT-target and ventricular segments. Difficulties in cardiac anatomical orientation on traditional radiation oncology CT scans appear to be an important driver of variability. This evaluation of the baseline observer variation shows that there is a need for methods and tools to improve variability and allows for future comparison of interventions aiming to reduce observer variation.

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Section: Discussionmentioning

confidence: 99%

Interobserver Variability in Target Definition for Stereotactic Arrhythmia Radioablation

Ree

Cuculich

Herk

et al. 2023

Preprint

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“…Currently, STAR treatment is only used in patients with refractory VT. As a result, eligible patients are highly complex. Peer review of targets has demonstrated to increase contour agreement in radiation oncology ( 22 ). Potentially, by discussing and delineating cases with cardiologist-electrophysiologists (or in multi-disciplinary teams including a radiation oncologist and radiologist) a reduction in interobserver variability could be achieved as well.…”

Section: Discussionmentioning

confidence: 99%

Interobserver variability in target definition for stereotactic arrhythmia radioablation

van der Ree,

Cuculich,

van Herk

et al. 2023

Front. Cardiovasc. Med.

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BackgroundStereotactic arrhythmia radioablation (STAR) is a potential new therapy for patients with refractory ventricular tachycardia (VT). The arrhythmogenic substrate (target) is synthesized from clinical and electro-anatomical information. This study was designed to evaluate the baseline interobserver variability in target delineation for STAR.MethodsDelineation software designed for research purposes was used. The study was split into three phases. Firstly, electrophysiologists delineated a well-defined structure in three patients (spinal canal). Secondly, observers delineated the VT-target in three patients based on case descriptions. To evaluate baseline performance, a basic workflow approach was used, no advanced techniques were allowed. Thirdly, observers delineated three predefined segments from the 17-segment model. Interobserver variability was evaluated by assessing volumes, variation in distance to the median volume expressed by the root-mean-square of the standard deviation (RMS-SD) over the target volume, and the Dice-coefficient.ResultsTen electrophysiologists completed the study. For the first phase interobserver variability was low as indicated by low variation in distance to the median volume (RMS-SD range: 0.02–0.02 cm) and high Dice-coefficients (mean: 0.97 ± 0.01). In the second phase distance to the median volume was large (RMS-SD range: 0.52–1.02 cm) and the Dice-coefficients low (mean: 0.40 ± 0.15). In the third phase, similar results were observed (RMS-SD range: 0.51–1.55 cm, Dice-coefficient mean: 0.31 ± 0.21).ConclusionsInterobserver variability is high for manual delineation of the VT-target and ventricular segments. This evaluation of the baseline observer variation shows that there is a need for methods and tools to improve variability and allows for future comparison of interventions aiming to reduce observer variation, for STAR but possibly also for catheter ablation.

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Roadmap: proton therapy physics and biology

Paganetti¹,

Beltran²,

Both³

et al. 2021

Phys. Med. Biol.

111

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The treatment of cancer with proton radiation therapy was first suggested in 1946 followed by the first treatments in the 1950s. As of 2020, almost 200 000 patients have been treated with proton beams worldwide and the number of operating proton therapy (PT) facilities will soon reach one hundred. PT has long moved from research institutions into hospital-based facilities that are increasingly being utilized with workflows similar to conventional radiation therapy. While PT has become mainstream and has established itself as a treatment option for many cancers, it is still an area of active research for various reasons: the advanced dose shaping capabilities of PT cause susceptibility to uncertainties, the high degrees of freedom in dose delivery offer room for further improvements, the limited experience and understanding of optimizing pencil beam scanning, and the biological effect difference compared to photon radiation. In addition to these challenges and opportunities currently being investigated, there is an economic aspect because PT treatments are, on average, still more expensive compared to conventional photon based treatment options. This roadmap highlights the current state and future direction in PT categorized into four different themes, 'improving efficiency', 'improving planning and delivery', 'improving imaging', and 'improving patient selection'.

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Impact of Peer Review in Reducing Uncertainty in the Definition of the Lung Target Volume Among Trainee Oncologists

Cited by 3 publications

References 30 publications

Interobserver Variability in Target Definition for Stereotactic Arrhythmia Radioablation

Interobserver Variability in Target Definition for Stereotactic Arrhythmia Radioablation

Interobserver variability in target definition for stereotactic arrhythmia radioablation

Roadmap: proton therapy physics and biology

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