Contouring Variations and the Role of Atlas in Non-small Cell Lung Cancer Radiation Therapy: Analysis of a Multi-institutional Preclinical Trial Planning Study

Overview

Journal Pract Radiat Oncol

Publisher Elsevier

Specialties Oncology
Radiology

Date 2014 Nov 22

PMID 25413413

Citations 13

Authors

Yunfeng Cui

Wenzhou Chen

Feng-Ming Spring Kong

Lindsey A Olsen

Ronald E Beatty

Peter G Maxim

Timothy Ritter

Jason W Sohn

Jane Higgins

James M Galvin

Ying Xiao

Affiliations

Soon will be listed here.

Abstract

Purpose: To quantify variations in target and normal structure contouring and evaluate dosimetric impact of these variations in non-small cell lung cancer (NSCLC) cases. To study whether providing an atlas can reduce potential variation.

Methods And Materials: Three NSCLC cases were distributed sequentially to multiple institutions for contouring and radiation therapy planning. No segmentation atlas was provided for the first 2 cases (Case 1 and Case 2). Contours were collected from submitted plans and consensus contour sets were generated. The volume variation among institution contours and the deviation of them from consensus contours were analyzed. The dose-volume histograms for individual institution plans were recalculated using consensus contours to quantify the dosimetric changes. An atlas containing targets and critical structures was constructed and was made available when the third case (Case 3) was distributed for planning. The contouring variability in the submitted plans of Case 3 was compared with that in first 2 cases.

Results: Planning target volume (PTV) showed large variation among institutions. The PTV coverage in institutions' plans decreased dramatically when reevaluated using the consensus PTV contour. The PTV contouring consistency did not show improvement with atlas use in Case 3. For normal structures, lung contours presented very good agreement, while the brachial plexus showed the largest variation. The consistency of esophagus and heart contouring improved significantly (t test; P < .05) in Case 3. Major factors contributing to the contouring variation were identified through a survey questionnaire.

Conclusions: The amount of contouring variations in NSCLC cases was presented. Its impact on dosimetric parameters can be significant. The segmentation atlas improved the contour agreement for esophagus and heart, but not for the PTV in this study. Quality assurance of contouring is essential for a successful multi-institutional clinical trial.

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