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Stockinger M, Karle H, Rennau H, et al. Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact. Radiat Oncol. 2021;16(1):241doi: 10.1186/s13014-021-01965-5.
Stockinger, M., Karle, H., Rennau, H., Sebb, S., Wolf, U., Remmele, J., Bührdel, S., Bartkowiak, D., Blettner, M., Schmidberger, H., & Wollschläger, D. (2021). Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact. Radiation oncology (London, England), 16(1), 241. https://doi.org/10.1186/s13014-021-01965-5
Stockinger, Marcus, et al. "Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact." Radiation oncology (London, England) vol. 16,1 (2021): 241. doi: https://doi.org/10.1186/s13014-021-01965-5
Stockinger M, Karle H, Rennau H, Sebb S, Wolf U, Remmele J, Bührdel S, Bartkowiak D, Blettner M, Schmidberger H, Wollschläger D. Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact. Radiat Oncol. 2021 Dec 20;16(1):241. doi: 10.1186/s13014-021-01965-5. PMID: 34930360; PMCID: PMC8691015.
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Radiat Oncol. 2021 Dec 20;16(1):241. doi: 10.1186/s13014-021-01965-5.

Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact.

Radiation oncology (London, England)

Marcus Stockinger, Heiko Karle, Hannes Rennau, Sabine Sebb, Ulrich Wolf, Julia Remmele, Sandra Bührdel, Detlef Bartkowiak, Maria Blettner, Heinz Schmidberger, Daniel Wollschläger

Affiliations

  1. Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
  2. Department of Radiation Oncology, University Hospital Rostock, Südring 75, 18059, Rostock, Germany.
  3. Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany.
  4. Department of Radiation Oncology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
  5. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.
  6. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany. [email protected].

PMID: 34930360 PMCID: PMC8691015 DOI: 10.1186/s13014-021-01965-5

Abstract

PURPOSE: Cardiac effects after breast cancer radiation therapy potentially affect more patients as survival improves. The heart's heterogeneous radiation exposure and composition of functional structures call for establishing individual relationships between structure dose and specific late effects. However, valid dosimetry requires reliable contouring which is challenging for small volumes based on older, lower-quality computed tomography imaging. We developed a heart atlas for robust heart contouring in retrospective epidemiologic studies.

METHODS AND MATERIALS: The atlas defined the complete heart and geometric surrogate volumes for six cardiac structures: aortic valve, pulmonary valve, all deeper structures combined, myocardium, left anterior myocardium, and right anterior myocardium. We collected treatment planning records from 16 patients from 4 hospitals including dose calculations for 3D conformal tangential field radiation therapy for left-sided breast cancer. Six observers each contoured all patients. We assessed spatial contouring agreement and corresponding dosimetric variability.

RESULTS: Contouring agreement for the complete heart was high with a mean Jaccard similarity coefficient (JSC) of 89%, a volume coefficient of variation (CV) of 5.2%, and a mean dose CV of 4.2%. The left (right) anterior myocardium had acceptable agreement with 63% (58%) JSC, 9.8% (11.5%) volume CV, and 11.9% (8.0%) mean dose CV. Dosimetric agreement for the deep structures and aortic valve was good despite higher spatial variation. Low spatial agreement for the pulmonary valve translated to poor dosimetric agreement.

CONCLUSIONS: For the purpose of retrospective dosimetry based on older imaging, geometric surrogate volumes for cardiac organs at risk can yield better contouring agreement than anatomical definitions, but retain limitations for small structures like the pulmonary valve.

© 2021. The Author(s).

Keywords: Atlas; Contouring; Heart dose; Retrospective dosimetry

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