A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning
A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning
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DOI：
10.1016/j.ijrobp.2012.02.003
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发表时间：
2012-08-01
影响因子：
7
通讯作者：
Roeske, John C.
中科院分区：
文献类型：
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作者：
Breunig, Jennifer;Hernandez, Sophy;Roeske, John C.
目的：实施“计划-执行-检查-行动”（PDCA）循环，对用于放射治疗治疗计划的正常组织轮廓进行持续质量改进。方法与材料：本研究选择脑、头颈部、胸腔、胰腺、前列腺肿瘤患者的CT扫描。对于每次扫描，放射肿瘤学家和诊断放射科医生根据放射治疗肿瘤小组（RTOG）的指导方针勾勒出正常组织（“金色”轮廓）。共划定了30个器官。然后，5名委员会认证的剂量师和1名受训人员分别勾勒出相同的器官。用于比较剂量测定师的轮廓和黄金轮廓之间的一致性的指标包括骰子相似系数（DSC），以及使用距离来一致的惩罚函数。根据这些分数，剂量学家对那些没有获得及格分数的器官进行了重新培训，随后对他们进行了重新测试。结果：30个脏器中有19个脏器评分合格。这些评分与器官体积相关。当器官体积= 8 cc时，平均DSC为0.91 （P= 0.005）。得分最低的正常组织包括晶状体、视神经、交叉、耳蜗和食道。在考虑重新检测的11个器官中，有10个器官的平均得分有所改善，在教育和重新评估后，这些器官中有一半以上的器官有统计学上显著的改善。结论：本研究的结果表明，应用PDCA循环来评估个体器官划分的能力，并确定需要改进的领域是可行的。通过测试、指导和重新评估，可以在多个剂量师之间获得轮廓一致性。我们的期望是使用PDCA方法的持续质量改进将确保在放疗治疗计划和交付中更准确的治疗和剂量评估。(C) 2012爱思唯尔公司
Purpose: To implement the "plan-do-check-act" (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning.Methods and Materials: The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues ("gold" contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested.Results: Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes = 8 cc, for which the average DSC was 0.91 (P=.005). Normal tissues that had the lowest scores included the lenses, optic nerves, chiasm, cochlea, and esophagus. Of the 11 organs that were considered for re-testing, 10 showed improvement in the average score, and statistically significant improvement was noted in more than half of these organs after education and re-assessment.Conclusions: The results of this study indicate the feasibility of applying the PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose assessment in radiotherapy treatment planning and delivery. (C) 2012 Elsevier Inc.