An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting

Hesham Elhalawani; Baher Elgohari; Timothy A. Lin; Abdallah S.R. Mohamed; Thomas J. Fitzgerald; Fran Laurie; Kenneth Ulin; Jayashree Kalpathy-Cramer; Thomas Guerrero; Emma B. Holliday; Gregory Russo; Abhilasha Patel; William Jones; Gary V. Walker; Musaddiq Awan; Mehee Choi; Roi Dagan; Omar Mahmoud; Anna Shapiro; Feng Ming (Spring) Kong; Daniel Gomez; Jing Zeng; Roy Decker; Femke O.B. Spoelstra; Laurie E. Gaspar; Lisa A. Kachnic; Charles R. Thomas; Paul Okunieff; Clifton D. Fuller

doi:10.1016/j.ctro.2019.01.001

An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting

Hesham Elhalawani, Baher Elgohari, Timothy A. Lin, Abdallah S.R. Mohamed, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Jayashree Kalpathy-Cramer, Thomas Guerrero, Emma B. Holliday, Gregory Russo, Abhilasha Patel, William Jones, Gary V. Walker, Musaddiq Awan, Mehee Choi, Roi Dagan, Omar Mahmoud, Anna Shapiro, Feng Ming (Spring) KongDaniel Gomez, Jing Zeng, Roy Decker, Femke O.B. Spoelstra, Laurie E. Gaspar, Lisa A. Kachnic, Charles R. Thomas, Paul Okunieff, Clifton D. Fuller

Radiation Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results: When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions: High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.

Original language	English (US)
Pages (from-to)	83-92
Number of pages	10
Journal	Clinical and Translational Radiation Oncology
Volume	15
DOIs	https://doi.org/10.1016/j.ctro.2019.01.001
State	Published - Feb 2019

Keywords

Contouring
Pancoast tumor
QA
Quality assurance
Target volumes
Thoracic

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging

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10.1016/j.ctro.2019.01.001

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Elhalawani, H., Elgohari, B., Lin, T. A., Mohamed, A. S. R., Fitzgerald, T. J., Laurie, F., Ulin, K., Kalpathy-Cramer, J., Guerrero, T., Holliday, E. B., Russo, G., Patel, A., Jones, W., Walker, G. V., Awan, M., Choi, M., Dagan, R., Mahmoud, O., Shapiro, A., ... Fuller, C. D. (2019). An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting. Clinical and Translational Radiation Oncology, 15, 83-92. https://doi.org/10.1016/j.ctro.2019.01.001

Elhalawani, H, Elgohari, B, Lin, TA, Mohamed, ASR, Fitzgerald, TJ, Laurie, F, Ulin, K, Kalpathy-Cramer, J, Guerrero, T, Holliday, EB, Russo, G, Patel, A, Jones, W, Walker, GV, Awan, M, Choi, M, Dagan, R, Mahmoud, O, Shapiro, A, Kong, FM, Gomez, D, Zeng, J, Decker, R, Spoelstra, FOB, Gaspar, LE, Kachnic, LA, Thomas, CR, Okunieff, P & Fuller, CD 2019, 'An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting', Clinical and Translational Radiation Oncology, vol. 15, pp. 83-92. https://doi.org/10.1016/j.ctro.2019.01.001

@article{ed06225a1e0244458761ee974eac74bb,

title = "An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting",

abstract = "Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the {\textquoteleft}Experts{\textquoteright} for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants{\textquoteright} contours were then compared with Experts{\textquoteright} STAPLE contours. Results: When compared to the Experts{\textquoteright} STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions: High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.",

keywords = "Contouring, Pancoast tumor, QA, Quality assurance, Target volumes, Thoracic",

author = "Hesham Elhalawani and Baher Elgohari and Lin, {Timothy A.} and Mohamed, {Abdallah S.R.} and Fitzgerald, {Thomas J.} and Fran Laurie and Kenneth Ulin and Jayashree Kalpathy-Cramer and Thomas Guerrero and Holliday, {Emma B.} and Gregory Russo and Abhilasha Patel and William Jones and Walker, {Gary V.} and Musaddiq Awan and Mehee Choi and Roi Dagan and Omar Mahmoud and Anna Shapiro and Kong, {Feng Ming (Spring)} and Daniel Gomez and Jing Zeng and Roy Decker and Spoelstra, {Femke O.B.} and Gaspar, {Laurie E.} and Kachnic, {Lisa A.} and Thomas, {Charles R.} and Paul Okunieff and Fuller, {Clifton D.}",

note = "Publisher Copyright: {\textcopyright} 2019 The Authors",

year = "2019",

month = feb,

doi = "10.1016/j.ctro.2019.01.001",

language = "English (US)",

volume = "15",

pages = "83--92",

journal = "Clinical and Translational Radiation Oncology",

issn = "2405-6308",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting

AU - Elhalawani, Hesham

AU - Elgohari, Baher

AU - Lin, Timothy A.

AU - Mohamed, Abdallah S.R.

AU - Fitzgerald, Thomas J.

AU - Laurie, Fran

AU - Ulin, Kenneth

AU - Kalpathy-Cramer, Jayashree

AU - Guerrero, Thomas

AU - Holliday, Emma B.

AU - Russo, Gregory

AU - Patel, Abhilasha

AU - Jones, William

AU - Walker, Gary V.

AU - Awan, Musaddiq

AU - Choi, Mehee

AU - Dagan, Roi

AU - Mahmoud, Omar

AU - Shapiro, Anna

AU - Kong, Feng Ming (Spring)

AU - Gomez, Daniel

AU - Zeng, Jing

AU - Decker, Roy

AU - Spoelstra, Femke O.B.

AU - Gaspar, Laurie E.

AU - Kachnic, Lisa A.

AU - Thomas, Charles R.

AU - Okunieff, Paul

AU - Fuller, Clifton D.

PY - 2019/2

Y1 - 2019/2

N2 - Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results: When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions: High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.

AB - Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results: When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions: High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.

KW - Contouring

KW - Pancoast tumor

KW - QA

KW - Quality assurance

KW - Target volumes

KW - Thoracic

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SP - 83

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JO - Clinical and Translational Radiation Oncology

JF - Clinical and Translational Radiation Oncology

ER -

An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting

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Keywords

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