3D Variation in delineation of head and neck organs at risk.
3D Variation in delineation of head and neck organs at risk.
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DOI：
10.1186/1748-717x-7-32
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发表时间：
2012-03-13
期刊：
影响因子：
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通讯作者：
van 't Veld AA
中科院分区：
文献类型：
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作者：
Brouwer CL;Steenbakkers RJ;van den Heuvel E;Duppen JC;Navran A;Bijl HP;Chouvalova O;Burlage FR;Meertens H;Langendijk JA;van 't Veld AA
随着高适形和适应性放疗技术的日益普及，对患者解剖结构的一致描绘变得越来越重要。本研究通过应用描绘指南调查了头颈部危险器官（OARs）的观察者间变异性的大小和三维定位，以建立减少目前描绘实践中冗余变异性的措施。5名经验丰富的放射肿瘤学家在一组12例头颈部患者的脊髓、腮腺和下颌下腺、甲状腺软骨和声门喉部的CT扫描中研究了观察者之间的差异。对于所有的桨，计算了三个终点：类内相关系数（ICC）、一致性指数（CI）和三维变异测量（3D SD）。所有终点均显示声门喉部的观察者间差异最大（ICC = 0.27，平均CI = 0.37, 3D SD = 3.9 mm）。其他桨叶的描绘更一致（范围，ICC = 0.32-0.83，平均CI = 0.64-0.71, 3D SD = 0.9-2.6 mm）。桨叶的颅、尾和内侧区域表现出最大的差异。所有终点均为改进圈定实践提供了支持。圈定的变化可以追溯到几个区域原因。减少这种变化的措施可以：(1)制定指南，(2)联合划定审查会议和(3)应用多模态成像。为了规范患者的治疗，需要改进圈定实践。
Consistent delineation of patient anatomy becomes increasingly important with the growing use of highly conformal and adaptive radiotherapy techniques. This study investigates the magnitude and 3D localization of interobserver variability of organs at risk (OARs) in the head and neck area with application of delineation guidelines, to establish measures to reduce current redundant variability in delineation practice. Interobserver variability among five experienced radiation oncologists was studied in a set of 12 head and neck patient CT scans for the spinal cord, parotid and submandibular glands, thyroid cartilage, and glottic larynx. For all OARs, three endpoints were calculated: the Intraclass Correlation Coefficient (ICC), the Concordance Index (CI) and a 3D measure of variation (3D SD). All endpoints showed largest interobserver variability for the glottic larynx (ICC = 0.27, mean CI = 0.37 and 3D SD = 3.9 mm). Better agreement in delineations was observed for the other OARs (range, ICC = 0.32-0.83, mean CI = 0.64-0.71 and 3D SD = 0.9-2.6 mm). Cranial, caudal, and medial regions of the OARs showed largest variations. All endpoints provided support for improvement of delineation practice. Variation in delineation is traced to several regional causes. Measures to reduce this variation can be: (1) guideline development, (2) joint delineation review sessions and (3) application of multimodality imaging. Improvement of delineation practice is needed to standardize patient treatments.