Development and Validation of a Heart Atlas to Study Cardiac Exposure to Radiation Following Treatment for Breast Cancer

Journal Article · Sat Jan 01 00:00:00 EST 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.10.058· OSTI ID:21491530

Feng, Mary ^[1]; Moran, Jean M ^[1]; Koelling, Todd ^[2]; Chughtai, Aamer ^[3]; Chan, June L; Freedman, Laura; Hayman, James A; Jagsi, Reshma; Jolly, Shruti; Larouere, Janice; Soriano, Julie; Marsh, Robin; Pierce, Lori J ^[1]

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1. Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)
2. Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)
3. Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan (United States)

Purpose: Cardiac toxicity is an important sequela of breast radiotherapy. However, the relationship between dose to cardiac structures and subsequent toxicity has not been well defined, partially due to variations in substructure delineation, which can lead to inconsistent dose reporting and the failure to detect potential correlations. Here we have developed a heart atlas and evaluated its effect on contour accuracy and concordance. Methods and Materials: A detailed cardiac computed tomography scan atlas was developed jointly by cardiology, cardiac radiology, and radiation oncology. Seven radiation oncologists were recruited to delineate the whole heart, left main and left anterior descending interventricular branches, and right coronary arteries on four cases before and after studying the atlas. Contour accuracy was assessed by percent overlap with gold standard atlas volumes. The concordance index was also calculated. Standard radiation fields were applied. Doses to observer-contoured cardiac structures were calculated and compared with gold standard contour doses. Pre- and post-atlas values were analyzed using a paired t test. Results: The cardiac atlas significantly improved contour accuracy and concordance. Percent overlap and concordance index of observer-contoured cardiac and gold standard volumes were 2.3-fold improved for all structures (p < 0.002). After application of the atlas, reported mean doses to the whole heart, left main artery, left anterior descending interventricular branch, and right coronary artery were within 0.1, 0.9, 2.6, and 0.6 Gy, respectively, of gold standard doses. Conclusions: This validated University of Michigan cardiac atlas may serve as a useful tool in future studies assessing cardiac toxicity and in clinical trials which include dose volume constraints to the heart.

• OSTI ID: 21491530
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2009.10.058; PII: S0360-3016(09)03536-6; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPUTERIZED TOMOGRAPHY
CORONARIES
HEART
MAMMARY GLANDS
NEOPLASMS
RADIATION DOSES
RADIOTHERAPY
TOXICITY
VALIDATION
ARTERIES
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
DIAGNOSTIC TECHNIQUES
DISEASES
DOSES
GLANDS
MEDICINE
NUCLEAR MEDICINE
ORGANS
RADIOLOGY
TESTING
THERAPY
TOMOGRAPHY