Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Rumley, C.; Hansen, Christian Rønn; Jameson, Michael; Trada, Yuvnik; Johansen, Jørgen; Gyldenkerne, Niels; Eriksen, Jesper Grau; Aly, Farhannah; Christensen, Rasmus L.; Lee, Mark T; Brink, Carsten; Holloway, Lois

doi:10.1016/j.ctro.2022.08.005

Cited by 7 publications

(7 citation statements)

References 51 publications

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“…In addition to the points discussed above, it is important to emphasize the potential clinical implications of improved cochlea delineation in radiotherapy contouring. Accurate delineation of organs at risk (OARs) is a crucial step in radiation therapy planning, as it directly impacts the dose distribution and, consequently, the potential side effects and treatment outcomes [ 18 ]. In the case of the cochlea, precise contouring is particularly important, as the organ is responsible for hearing and is sensitive to radiation-induced damage [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Achieving Exceptional Cochlea Delineation in Radiotherapy Scans: The Impact of Optimal Window Width and Level Settings

Shanbhag¹,

Sumaida²,

Saleh³

2023

Cureus

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Introduction Radiation therapy (RT) aims to maximize the dose to the target volume while minimizing the dose to organs at risk (OAR), which is crucial for optimal treatment outcomes and minimal side effects. The complex anatomy of the head and neck regions, including the cochlea, presents challenges in radiotherapy. Accurate delineation of the cochlea is essential to prevent toxicities such as sensorineural hearing loss. Educational interventions, including seminars, atlases, and multidisciplinary discussions, can improve accuracy and interobserver agreement in contouring. This study seeks to provide radiation oncology practitioners with the necessary window width and window level settings in computed tomography (CT) scans to accurately and precisely delineate the cochlea, using a pre-and post-learning phase approach to assess the change in accuracy. Methods and materials The study used the ProKnow Contouring Accuracy Program (ProKnow, LLC, Florida, United States), which employs the StructSure method and the Dice coefficient to assess the precision of a user's contour compared to an expert contour. The StructSure method offers superior sensitivity and accuracy, while the Dice coefficient is a more rudimentary and less sensitive approach. Two datasets of CT scans, one for each left and right cochlea, were used. The author delineated the cochlea before and after applying the proposed technique for window width and window level, comparing the results with those of the expert and general population. The study included a step-by-step method for cochlea delineation using window width and window level settings. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results The implementation of the proposed step-by-step method for adjusting window width and window level led to significant improvements in contouring accuracy and delineation quality in radiation therapy planning. Comparing pre- and post-intervention scenarios, the author exhibited increased StructSure scores (right cochlea: 88.81 to 99.15; left cochlea: 88.45 to 99.85) and Dice coefficient scores (right cochlea: 0.62 to 0.80; left cochlea: 0.73 to 0.86). The author consistently demonstrated higher contouring accuracy and greater similarity to expert contours compared to the group's mean scores both before and after the intervention. These results suggest that the proposed method enhances the precision of cochlea delineation in radiotherapy planning. Conclusion In conclusion, this study demonstrated that a step-by-step instructional approach for adjusting window width and window level significantly improved cochlea delineation accuracy in radiotherapy contouring. The findings hold potential clinical implications for reducing radiation-related side effects and improving patient outcomes. This study supports the integration of the instructional technique into radiation oncology training and e...

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Section: Discussionmentioning

confidence: 99%

Achieving Exceptional Cochlea Delineation in Radiotherapy Scans: The Impact of Optimal Window Width and Level Settings

Shanbhag¹,

Sumaida²,

Saleh³

2023

Cureus

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“…The impact of poorer quality MRIs in radiation oncology contouring has been reported, particularly in the context of specified radiation oncology set-ups including immobilisation, which can create a challenge for optimal coil placement and is an area for further exploration in the MRL setting. 5,14 Inter-observer variability in radiation oncology contouring is well documented, with training/education initiatives aimed at reducing this. Khoo et al 15 reported on the reduction of both inter-and intra-observer contour variation in prostate contouring following an education program.…”

Section: Discussionmentioning

confidence: 99%

“…While the same datasets were being scored, we suggest that the increase in both the VGA scores and confidence were due to the training increasing the participant's knowledge of the MR‐specifics and, therefore, scored more positively. The impact of poorer quality MRIs in radiation oncology contouring has been reported, particularly in the context of specified radiation oncology set‐ups including immobilisation, which can create a challenge for optimal coil placement and is an area for further exploration in the MRL setting 5,14 …”

Section: Discussionmentioning

confidence: 99%

Improvement in male pelvis magnetic resonance image contouring following radiologist‐delivered training

Oar,

Brown,

Newman

et al. 2023

J of Medical Radiation Sci

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IntroductionThe magnetic resonance linear accelerator (MRL) combines both magnetic resonance imaging and a linear accelerator, allowing for daily treatment adaptation. This study aimed to assess the impact of radiologist‐delivered training in magnetic resonance (MR) contouring of relevant structures within the male pelvis.MethodsTwo radiation oncologists, two radiation oncology registrars and seven radiation therapists completed contouring on 10 male pelvis MR datasets both pre‐ and post‐training. A 2‐hour MR anatomy training session was delivered by a radiologist, who also provided the ‘gold standard’ contours. The pre‐ and post‐training contours were compared against the gold standard with Dice similarity coefficient (DSC) and Hausdorff distances calculated; and the pre‐ and post‐confidence scores and timing were compared.ResultsThe improvement in DSC were significant in prostate, rectum and seminal vesicles, with a post‐training median DSC of 0.87 ± 0.06, 0.92 ± 0.04 and 0.80 ± 0.14, respectively. The median Hausdorff improved with a median of 1.46 ± 0.78 mm, 0.52 ± 0.32 mm and 1.11 ± 0.86 mm for prostate, rectum and seminal vesicles, respectively. Bladder concordance was high both pre‐ and post‐training. Urethra contours improved post‐training, however, remained difficult to contour with a median post‐DSC of 0.51 ± 0.24. Overall, confidence scoring improved (P < 0.001) and timing decreased by an average of 4.4 ± 16.4 min post‐training.ConclusionRadiologist‐delivered training improved concordance of male pelvis contouring on MR datasets. Further work is required in the identification of urethra on MRs. These findings are of importance in the MRL adaptive workflow.

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“…Traditionally, radiologists manually delineate the tumor boundaries on CT and MR images in HNC; however, this is a time-consuming process and prone to high inter-reader variability due to the morphological complexity of HNC and potential artifacts. 12 , 13 Accurate delineation of OARs and tumor volumes is critical for minimizing radiation toxicities and maximizing tumor control in HNC’s concurrent chemoradiotherapy (CCRT) planning. 14 Atlas-based segmentation has proven to be a promising time-saving method for contouring HNC patients undergoing RT or CCRT.…”

Section: Introductionmentioning

confidence: 99%

Auto-segmentation of neck nodal metastases using self-distilled masked image transformer on longitudinal MR images

Paudyal,

Jiang,

Han

et al. 2024

BJR|Artificial Intelligence

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Objectives Auto-segmentation promises greater speed and lower inter-reader variability than manual segmentations in radiation oncology clinical practice. This study aims to implement and evaluate the accuracy of the auto-segmentation algorithm, “Masked Image modeling using the vision Transformers (SMIT),” for neck nodal metastases on longitudinal T2-weighted (T2w) MR images in oropharyngeal squamous cell carcinoma (OPSCC) patients. Methods This prospective clinical trial study included 123 human papillomaviruses (HPV-positive [+]) related OSPCC patients who received concurrent chemoradiotherapy. T2w MR images were acquired on 3 T at pre-treatment (Tx), week 0, and intra-Tx weeks (1-3). Manual delineations of metastatic neck nodes from 123 OPSCC patients were used for the SMIT auto-segmentation, and total tumor volumes were calculated. Standard statistical analyses compared contour volumes from SMIT vs manual segmentation (Wilcoxon signed-rank test [WSRT]), and Spearman’s rank correlation coefficients (ρ) were computed. Segmentation accuracy was evaluated on the test data set using the dice similarity coefficient (DSC) metric value. P-values <0.05 were considered significant. Results No significant difference in manual and SMIT delineated tumor volume at pre-Tx (8.68 ± 7.15 vs 8.38 ± 7.01 cm3, P = 0.26 [WSRT]), and the Bland-Altman method established the limits of agreement as –1.71 to 2.31 cm3, with a mean difference of 0.30 cm3. SMIT model and manually delineated tumor volume estimates were highly correlated (ρ = 0.84-0.96, P < 0.001). The mean DSC metric values were 0.86, 0.85, 0.77, and 0.79 at the pre-Tx and intra-Tx weeks (1-3), respectively. Conclusions The SMIT algorithm provides sufficient segmentation accuracy for oncological applications in HPV+ OPSCC. Advances in knowledge First evaluation of auto-segmentation with SMIT using longitudinal T2w MRI in HPV+ OPSCC.

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Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Cited by 7 publications

References 51 publications

Achieving Exceptional Cochlea Delineation in Radiotherapy Scans: The Impact of Optimal Window Width and Level Settings

Achieving Exceptional Cochlea Delineation in Radiotherapy Scans: The Impact of Optimal Window Width and Level Settings

Improvement in male pelvis magnetic resonance image contouring following radiologist‐delivered training

Auto-segmentation of neck nodal metastases using self-distilled masked image transformer on longitudinal MR images

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