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Title: Variability of Gross Tumor Volume Delineation in Head-and-Neck Cancer Using PET/CT Fusion, Part II: The Impact of a Contouring Protocol

Abstract

The purpose of this study was to assess the efficacy of a gross tumor volume (GTV) contouring protocol on interobserver variability between 4 physicians in positron emission therapy/computed tomography (PET/CT) treatment planning of head-and-neck cancer. A GTV contouring protocol for PET/CT treatment planning was developed utilizing 4 stages: Preliminary contouring on CT alone, determination of appropriate PET windowing, accurate image registration, and modification of CT contouring with correctly formatted PET/CT display and rules for modality disagreement. Two neuroradiologists and 2 radiation oncologists (designated as A, B, C, and D, respectively) were given a tutorial of PET/CT coregistered imaging individualized to their skill level, which included a step-by-step explanation of the protocol with clinical examples. Opportunities for questions and hands-on practice were given. The physicians were asked to re-contour 16 head-and-neck patients from Part I on PET/CT fusion imaging. Differences in volume magnitude were analyzed for statistical significance by analysis of variance (ANOVA) and paired t-tests ({alpha} < 0.05). Volume overlap was analyzed for statistical significance using Wilcoxon signed-rank tests ({alpha} < 0.05). Volume overlap increased significantly from Part I to Part II (p < 0.05). One previously significant difference between physicians disappeared with the protocol in place. The mean fusionmore » volume of Physician C, however, remained significantly larger than that of Physician D (p < 0.01). This result is unchanged from Part I. The multidisciplinary contouring protocol significantly improved the coincidence of GTVs contoured by multiple physicians. The magnitudes of the volumes showed marginal improvement in consistency. Developing an institutional contouring protocol for PET/CT treatment planning is highly recommended to reduce interobserver variability.« less

Authors:
 [1];  [2];  [3]; ; ; ; ; ; ;  [4];  [2];  [2];  [2]
  1. St. Vincent's Comprehensive Cancer Center, New York, NY (United StateS)
  2. (United States)
  3. (United States) and Mount Sinai Medical Center, New York, NY (United States), E-mail: aberson@aptiumoncology.com
  4. St. Vincent's Comprehensive Cancer Center, New York, NY (United States)
Publication Date:
OSTI Identifier:
21180438
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 34; Journal Issue: 1; Other Information: DOI: 10.1016/j.meddos.2007.08.003; PII: S0958-3947(07)00156-2; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The 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; HEAD; IMAGES; MEDICAL PERSONNEL; NECK; NEOPLASMS; PROTON COMPUTED TOMOGRAPHY

Citation Formats

Berson, Anthony M., St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, Stein, Nicholas F., Riegel, Adam C., Destian, Sylvie, Ng, Tracy, Tena, Lawrence B., Mitnick, Robin J., Heiba, Sherif, St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, and and Mount Sinai Medical Center, New York, NY. Variability of Gross Tumor Volume Delineation in Head-and-Neck Cancer Using PET/CT Fusion, Part II: The Impact of a Contouring Protocol. United States: N. p., 2009. Web. doi:10.1016/j.meddos.2007.08.003.
Berson, Anthony M., St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, Stein, Nicholas F., Riegel, Adam C., Destian, Sylvie, Ng, Tracy, Tena, Lawrence B., Mitnick, Robin J., Heiba, Sherif, St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, & and Mount Sinai Medical Center, New York, NY. Variability of Gross Tumor Volume Delineation in Head-and-Neck Cancer Using PET/CT Fusion, Part II: The Impact of a Contouring Protocol. United States. doi:10.1016/j.meddos.2007.08.003.
Berson, Anthony M., St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, Stein, Nicholas F., Riegel, Adam C., Destian, Sylvie, Ng, Tracy, Tena, Lawrence B., Mitnick, Robin J., Heiba, Sherif, St. Vincent's Hospital, New York, NY, New York Medical College, Valhalla, NY, and and Mount Sinai Medical Center, New York, NY. Wed . "Variability of Gross Tumor Volume Delineation in Head-and-Neck Cancer Using PET/CT Fusion, Part II: The Impact of a Contouring Protocol". United States. doi:10.1016/j.meddos.2007.08.003.
@article{osti_21180438,
title = {Variability of Gross Tumor Volume Delineation in Head-and-Neck Cancer Using PET/CT Fusion, Part II: The Impact of a Contouring Protocol},
author = {Berson, Anthony M. and St. Vincent's Hospital, New York, NY and New York Medical College, Valhalla, NY and Stein, Nicholas F. and Riegel, Adam C. and Destian, Sylvie and Ng, Tracy and Tena, Lawrence B. and Mitnick, Robin J. and Heiba, Sherif and St. Vincent's Hospital, New York, NY and New York Medical College, Valhalla, NY and and Mount Sinai Medical Center, New York, NY},
abstractNote = {The purpose of this study was to assess the efficacy of a gross tumor volume (GTV) contouring protocol on interobserver variability between 4 physicians in positron emission therapy/computed tomography (PET/CT) treatment planning of head-and-neck cancer. A GTV contouring protocol for PET/CT treatment planning was developed utilizing 4 stages: Preliminary contouring on CT alone, determination of appropriate PET windowing, accurate image registration, and modification of CT contouring with correctly formatted PET/CT display and rules for modality disagreement. Two neuroradiologists and 2 radiation oncologists (designated as A, B, C, and D, respectively) were given a tutorial of PET/CT coregistered imaging individualized to their skill level, which included a step-by-step explanation of the protocol with clinical examples. Opportunities for questions and hands-on practice were given. The physicians were asked to re-contour 16 head-and-neck patients from Part I on PET/CT fusion imaging. Differences in volume magnitude were analyzed for statistical significance by analysis of variance (ANOVA) and paired t-tests ({alpha} < 0.05). Volume overlap was analyzed for statistical significance using Wilcoxon signed-rank tests ({alpha} < 0.05). Volume overlap increased significantly from Part I to Part II (p < 0.05). One previously significant difference between physicians disappeared with the protocol in place. The mean fusion volume of Physician C, however, remained significantly larger than that of Physician D (p < 0.01). This result is unchanged from Part I. The multidisciplinary contouring protocol significantly improved the coincidence of GTVs contoured by multiple physicians. The magnitudes of the volumes showed marginal improvement in consistency. Developing an institutional contouring protocol for PET/CT treatment planning is highly recommended to reduce interobserver variability.},
doi = {10.1016/j.meddos.2007.08.003},
journal = {Medical Dosimetry},
number = 1,
volume = 34,
place = {United States},
year = {Wed Apr 01 00:00:00 EDT 2009},
month = {Wed Apr 01 00:00:00 EDT 2009}
}