Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

Ciardo, D.; Argenone, Angela; Boboc, Genoveva Ionela; Cucciarelli, F.; Rose, F. De; Santis, Maria Carmen De; Huscher, Alessandra; Ippolito, Edy; Porta, Maria Rosa La; Marino, Lorenza; Meaglia, Ilaria; Palumbo, Isabella; Rossi, Francesca; Alpi, P.; Bignardi, Mario; Bonanni, A.; Cante, Domenico; Ceschia, Tino; Fabbietti, Letizia; Lupattelli, Marco; Mantero, E; Monaco, Angelo; Pantano, Patrizia; Ravo, Vincenzo; Silipigni, S.; Tozzi, A.; Umina, Vincenza; Zerini, Dario; Bordonaro, L.; Capezzali, G.; Clerici, Elena; Colangione, Sarah Pia; Dispinzieri, M.; Dognini, J.; Donadoni, L.; Falivene, Sara; Fozza, Alessandra; Grilli, Barbara; Guarnaccia, Roberta; Iannacone, Eva; Lancellotta, Valentina; Prisco, Agnese; Ricotti, R.; Orecchia, Roberto; Jereczek‐Fossa, Barbara Alicja; Leonardi, Maria Cristina

doi:10.1080/0284186x.2017.1325004

Cited by 21 publications

(13 citation statements)

References 40 publications

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“…In addition, the contouring process is burdened by time-consuming procedures which may slow the entire workflow. Apart from the introduction of atlas-based auto-contouring programs in the clinical practice, which proved to be beneficial in time reduction compared to the manual contouring [26], the possibility of expanding the role of CSRTs in the pre-planning phase represents a major asset. Several studies have already confirmed the great potential of CSRTs in normal tissue contouring in the head and neck and the pelvic districts [10][11][12][13]27].…”

Section: Discussionmentioning

confidence: 99%

The emerging role of radiation therapists in the contouring of organs at risk in radiotherapy: analysis of inter-observer variability with radiation oncologists for the chest and upper abdomen

Arculeo

Miglietta

Nava

et al. 2020

ecancer

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Aims: To compare the contouring of organs at risk (OAR) between a clinical specialist radiation therapist (CSRT) and radiation oncologists (ROs) with different levels of expertise (senior-SRO, junior-JRO, fellow-FRO). Methods: On ten planning computed tomography (CT) image sets of patients undergoing breast radiotherapy (RT), the observers independently contoured the contralateral breast, heart, left anterior descending artery (LAD), oesophagus, kidney, liver, spinal cord, stomach and trachea. The CSRT was instructed by the JRO e SRO. The inter-observer variability of contoured volumes was measured using the Dice similarity coefficient (DSC) (threshold of ≥ 0.7 for good concordance) and the centre of mass distance (CMD). The analysis of variance (ANOVA) was performed and a p-value < 0.01 was considered statistically significant. Results: Good overlaps (DSC > 0.7) were obtained for all OARs, except for LAD (DSC = 0.34 ± 0.17, mean ± standard deviation) and oesophagus (DSC = 0.66 ± 0.06, mean ± SD). The mean CMD < 1 cm was achieved for all the OARs, but spinal cord (CMD = 1.22 cm). By pairing the observers, mean DSC > 0.7 and mean CMD < 1 cm were achieved in all cases. The best overlaps were seen for the pairs JRO-CSRT(DSC = 0.82; CMD = 0.49 cm) and SRO-JRO (DSC = 0.80; CMD = 0.51 cm). Conclusions: Overall, good concordance was found for all the observers. Despite the short training in contouring, CSRT obtained good concordance with his tutor (JRO). Great variability was seen in contouring the LAD, due to its difficult visualization and identification of CT scans without contrast.

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Section: Discussionmentioning

confidence: 99%

The emerging role of radiation therapists in the contouring of organs at risk in radiotherapy: analysis of inter-observer variability with radiation oncologists for the chest and upper abdomen

Arculeo

Miglietta

Nava

et al. 2020

ecancer

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“…Several analyses were conducted to evaluate volume parameters related to CT scan and MRI and interobserver variability compared to the benchmark [15,[25][26][27]. Descriptive statistics (mean, standard deviation, range of variability, median, 25th and 75th percentile) was calculated for GTV and duodenum, delineated on CT and MRI, respectively.…”

Section: Statistical Analysesmentioning

confidence: 99%

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

et al. 2019

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Genovesi (2019) Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multiinstitutional contouring study on behalf of the AIRO group for gastrointestinal cancers, Acta Oncologica, 58:4, 439-447, ABSTRACT Background: Due to the high soft tissue resolution, magnetic resonance imaging (MRI) could improve the accuracy of pancreatic tumor delineation in radiation treatment planning. A multi-institutional study was proposed to evaluate the impact of MRI on inter-observer agreement in gross tumor volume (GTV) and duodenum delineation for pancreatic cancer compared with computer tomography (CT). Material and Methods: Two clinical cases of borderline resectable (Case 1) and unresectable (Case 2) pancreatic cancer were selected. In two sequential steps, diagnostic contrast-enhanced CT scan and MRI sequences were sent to the participating centers. CT-GTVs were contoured while blinded to MRI data sets. DICE index was used to evaluate the spatial overlap accuracy. Results: Thirty-one radiation oncologists from different Institutions submitted the delineated volumes. CT-and MRI-GTV mean volumes were 21.6 ± 9.0 cm 3 and 17.2 ± 6.0 cm 3 , respectively for Case 1, and 31.3 ± 15.6 cm 3 and 33.2 ± 20.2 cm 3 , respectively for Case 2. Resulting MRI-GTV mean volume was significantly smaller than CT-GTV in the borderline resectable case (p < .05). A substantial agreement was shown by the median DICE index for CT-and MRI-GTV resulting as 0.74 (IQR: 0.67-0.75) and 0.61 (IQR: 0.57-0.67) for Case 1; a moderate agreement was instead reported for Case 2: 0.59 (IQR:0.52-0.66) and 0.53 (IQR:0.42-0.62) for CT-and MRI-GTV, respectively. Conclusion: Diagnostic MRI resulted in smaller GTV in borderline resectable case with a substantial agreement between observers, and was comparable to CT scan in interobserver variability, in both cases. The greater variability in the unresectable case underlines the critical issues related to the outlining when vascular structures are more involved. The integration of MRI with contrast-enhancement CT, thanks to its high definition of tumor relationship with neighboring vessels, could offer a greater accuracy of target delineation.

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“…This personalized semi‐automated approach to radiotherapy treatment planning could become the future clinical standard, because the algorithm will take individual patient anatomy and treatment position into account once the anatomical landmarks are properly indicated. On top of that, several publications state that inter‐ and intra‐observer variability is high, even when delineations are made according to the same guidelines (as opposed to comparing delineations from different centers that might use slightly different guidelines) (Petersen et al ; Castro Pena et al ; Ciardo et al ). Automating the process of delineation is also expected to reduce this inter‐ and intra‐observer variability.…”

Section: Introductionmentioning

confidence: 99%

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

Stouthandel

Veldeman

Hoof

2019

The Anatomical Record

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This review intends to rekindle efforts to map the lymphatic system by using a more modern approach, based on medical imaging. The structure, function, and pathologies associated with the lymphatic system are first discussed to highlight the need for more accurately mapping the lymphatic system. Next, the need for an interdisciplinary approach, with a central role for the anatomist, to come up with better maps of the lymphatic system is emphasized. The current approaches on lymphatic system research involving medical imaging will be discussed and suggestions will be made for an all‐encompassing effort to thoroughly map the entire lymphatic system. A first‐hand account of our integration as anatomists in the radiotherapy department is given as an example of interdisciplinary collaboration. From this account, it will become clear that the interdisciplinary collaboration of anatomists in the clinical disciplines involved in lymphatic system research/treatment still holds great promise in terms of improving clinical regimens that are currently being employed. As such, we hope that our fellow anatomists will join us in an interdisciplinary effort to map the lymphatic system, because this could, in a relatively short timeframe, provide improved treatment options for patients with cancer or lymphatic pathologies all over the world. Anat Rec, 302:1681–1695, 2019. © 2019 American Association for Anatomy

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Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

Cited by 21 publications

References 40 publications

The emerging role of radiation therapists in the contouring of organs at risk in radiotherapy: analysis of inter-observer variability with radiation oncologists for the chest and upper abdomen

The emerging role of radiation therapists in the contouring of organs at risk in radiotherapy: analysis of inter-observer variability with radiation oncologists for the chest and upper abdomen

Magnetic resonance imaging (MRI) compared with computed tomography (CT) for interobserver agreement of gross tumor volume delineation in pancreatic cancer: a multi-institutional contouring study on behalf of the AIRO group for gastrointestinal cancers

Call for a Multidisciplinary Effort to Map the Lymphatic System with Advanced Medical Imaging Techniques: A Review of the Literature and Suggestions for Future Anatomical Research

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