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Title: An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658)

Abstract

Purpose: Accurate target definition is considered essential for sophisticated, image-guided radiation therapy; however, relatively little information has been reported that measures our ability to identify the precise shape of targets accurately. We decided to assess the manner in which eight 'experts' interpreted the size and shape of tumors based on 'real-life' contrast-enhanced computed tomographic (CT) scans. Methods and Materials: Four neuroradiologists and four radiation oncologists (the authors) with considerable experience and presumed expertise in treating head-and-neck tumors independently contoured, slice-by-slice, his/her interpretation of the precise gross tumor volume (GTV) on each of 20 sets of CT scans taken from 20 patients who previously were enrolled in Radiation Therapy Oncology Group protocol 91-11. Results: The average proportion of overlap (i.e., the degree of agreement) was 0.532 (95% confidence interval 0.457 to 0.606). There was a slight tendency for the proportion of overlap to increase with increasing average GTV. Conclusions: Our work suggests that estimation of tumor shape currently is imprecise, even for experienced physicians. In consequence, there appears to be a practical limit to the current trend of smaller fields and tighter margins.

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10];  [11];  [4];  [4]
  1. Department of Radiation Oncology, Maimonides Medical Center, Brooklyn, NY (United States). E-mail: jcooper@maimonidesmed.org
  2. Department of Radiology, University of Michigan Health System, Ann Arbor, MI (United States)
  3. (United States)
  4. Center for Statistical Sciences, Brown University, Providence, RI (United States)
  5. Department of Radiology, State University of New York, Albany Medical School, Albany, NY (United States)
  6. Department of Radiology, University of Florida School of Medicine, Gainesville, FL (United States)
  7. Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, FL (United States)
  8. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC (United States)
  9. Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)
  10. Department of Radiology, Bryn Mawr Hospital, Bryn Mawr, PA (United States)
  11. Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX (United States)
Publication Date:
OSTI Identifier:
20944751
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2006.10.029; PII: S0360-3016(06)03344-X; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; EVALUATION; HEAD; IMAGES; MEDICAL PERSONNEL; NECK; PATIENTS; RADIOTHERAPY

Citation Formats

Cooper, Jay S., Mukherji, Suresh K., Department of Otolaryngology Head Neck Surgery, University of Michigan Health System, Ann Arbor, MI, Toledano, Alicia Y., Beldon, Clifford, Schmalfuss, Ilona M., Amdur, Robert, Sailer, Scott, Loevner, Laurie A., Kousouboris, Phil, Ang, K. Kian, Cormack, Jean, and Sicks, JoRean M.S. An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658). United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.10.029.
Cooper, Jay S., Mukherji, Suresh K., Department of Otolaryngology Head Neck Surgery, University of Michigan Health System, Ann Arbor, MI, Toledano, Alicia Y., Beldon, Clifford, Schmalfuss, Ilona M., Amdur, Robert, Sailer, Scott, Loevner, Laurie A., Kousouboris, Phil, Ang, K. Kian, Cormack, Jean, & Sicks, JoRean M.S. An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658). United States. doi:10.1016/j.ijrobp.2006.10.029.
Cooper, Jay S., Mukherji, Suresh K., Department of Otolaryngology Head Neck Surgery, University of Michigan Health System, Ann Arbor, MI, Toledano, Alicia Y., Beldon, Clifford, Schmalfuss, Ilona M., Amdur, Robert, Sailer, Scott, Loevner, Laurie A., Kousouboris, Phil, Ang, K. Kian, Cormack, Jean, and Sicks, JoRean M.S. Thu . "An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658)". United States. doi:10.1016/j.ijrobp.2006.10.029.
@article{osti_20944751,
title = {An evaluation of the variability of tumor-shape definition derived by experienced observers from CT images of supraglottic carcinomas (ACRIN protocol 6658)},
author = {Cooper, Jay S. and Mukherji, Suresh K. and Department of Otolaryngology Head Neck Surgery, University of Michigan Health System, Ann Arbor, MI and Toledano, Alicia Y. and Beldon, Clifford and Schmalfuss, Ilona M. and Amdur, Robert and Sailer, Scott and Loevner, Laurie A. and Kousouboris, Phil and Ang, K. Kian and Cormack, Jean and Sicks, JoRean M.S.},
abstractNote = {Purpose: Accurate target definition is considered essential for sophisticated, image-guided radiation therapy; however, relatively little information has been reported that measures our ability to identify the precise shape of targets accurately. We decided to assess the manner in which eight 'experts' interpreted the size and shape of tumors based on 'real-life' contrast-enhanced computed tomographic (CT) scans. Methods and Materials: Four neuroradiologists and four radiation oncologists (the authors) with considerable experience and presumed expertise in treating head-and-neck tumors independently contoured, slice-by-slice, his/her interpretation of the precise gross tumor volume (GTV) on each of 20 sets of CT scans taken from 20 patients who previously were enrolled in Radiation Therapy Oncology Group protocol 91-11. Results: The average proportion of overlap (i.e., the degree of agreement) was 0.532 (95% confidence interval 0.457 to 0.606). There was a slight tendency for the proportion of overlap to increase with increasing average GTV. Conclusions: Our work suggests that estimation of tumor shape currently is imprecise, even for experienced physicians. In consequence, there appears to be a practical limit to the current trend of smaller fields and tighter margins.},
doi = {10.1016/j.ijrobp.2006.10.029},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 67,
place = {United States},
year = {Thu Mar 15 00:00:00 EDT 2007},
month = {Thu Mar 15 00:00:00 EDT 2007}
}