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      Automatic segmentation software in locally advanced rectal cancer: READY (REsearch program in Auto Delineation sYstem)-RECTAL 02: prospective study


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          To validate autocontouring software (AS) in a clinical practice including a two steps delineation quality assurance (QA) procedure.

          The existing delineation agreement among experts for rectal cancer and the overlap and time criteria that have to be verified to allow the use of AS were defined.

          Median Dice Similarity Coefficient (MDSC), Mean slicewise Hausdorff Distances (MSHD) and Total-Time saving (TT) were analyzed.

          Two expert Radiation Oncologists reviewed CT-scans of 44 patients and agreed the reference-CTV: the first 14 consecutive cases were used to populate the software Atlas and 30 were used as Test.

          Each expert performed a manual (group A) and an automatic delineation (group B) of 15 Test patients.

          The delineations were compared with the reference contours.

          The overlap between the manual and automatic delineations with MDSC and MSHD and the TT were analyzed.

          Three acceptance criteria were set: MDSC ≥ 0.75, MSHD ≤1mm and TT sparing ≥ 50%.

          At least 2 criteria had to be met, one of which had to be TT saving, to validate the system.

          The MDSC was 0.75, MSHD 2.00 mm and the TT saving 55.5% between group A and group B. MDSC among experts was 0.84.

          Autosegmentation systems in rectal cancer partially met acceptability criteria with the present version.

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          Most cited references23

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          Tumor delineation: The weakest link in the search for accuracy in radiotherapy

          C Njeh (2008)
          Radiotherapy is one of the most effective modalities for the treatment of cancer. However, there is a high degree of uncertainty associated with the target volume of most cancer sites. The sources of these uncertainties include, but are not limited to, the motion of the target, patient setup errors, patient movements, and the delineation of the target volume. Recently, many imaging techniques have been introduced to track the motion of tumors. The treatment delivery using these techniques is collectively called image-guided radiation therapy (IGRT). Ultimately, IGRT is only as good as the accuracy with which the target is known. There are reports of interobserver variability in tumor delineation across anatomical sites, but the widest ranges of variations have been reported for the delineation of head and neck tumors as well as esophageal and lung carcinomas. Significant interobserver variability in target delineation can be attributed to many factors including the impact of imaging and the influence of the observer (specialty, training, and personal bias). The visibility of the target can be greatly improved with the use of multimodality imaging by co-registration of CT with a second modality such as magnetic resonance imaging (MRI) and/or positron emission tomography. Also, continuous education, training, and cross-collaboration of the radiation oncologist with other specialties can reduce the degree of variability in tumor delineation.
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            Clinical validation of atlas-based auto-segmentation of multiple target volumes and normal tissue (swallowing/mastication) structures in the head and neck.

            To validate and clinically evaluate autocontouring using atlas-based autosegmentation (ABAS) of computed tomography images. The data from 10 head-and-neck patients were selected as input for ABAS, and neck levels I-V and 20 organs at risk were manually contoured according to published guidelines. The total contouring times were recorded. Two different ABAS strategies, multiple and single subject, were evaluated, and the similarity of the autocontours with the atlas contours was assessed using Dice coefficients and the mean distances, using the leave-one-out method. For 12 clinically treated patients, 5 experienced observers edited the autosegmented contours. The editing times were recorded. The Dice coefficients and mean distances were calculated among the clinically used contours, autocontours, and edited autocontours. Finally, an expert panel scored all autocontours and the edited autocontours regarding their adequacy relative to the published atlas. The time to autosegment all the structures using ABAS was 7 min/patient. No significant differences were observed in the autosegmentation accuracy for stage N0 and N+ patients. The multisubject atlas performed best, with a Dice coefficient and mean distance of 0.74 and 2 mm, 0.67 and 3 mm, 0.71 and 2 mm, 0.50 and 2 mm, and 0.78 and 2 mm for the salivary glands, neck levels, chewing muscles, swallowing muscles, and spinal cord-brainstem, respectively. The mean Dice coefficient and mean distance of the autocontours vs. the clinical contours was 0.8 and 2.4 mm for the neck levels and salivary glands, respectively. For the autocontours vs. the edited autocontours, the mean Dice coefficient and mean distance was 0.9 and 1.6 mm, respectively. The expert panel scored 100% of the autocontours as a "minor deviation, editable" or better. The expert panel scored 88% of the edited contours as good compared with 83% of the clinical contours. The total editing time was 66 min. Multiple-subject ABAS of computed tomography images proved to be a useful novel tool in the rapid delineation of target and normal tissues. Although editing of the autocontours is inevitable, a substantial time reduction was achieved using editing, instead of manual contouring (180 vs. 66 min). Copyright © 2011 Elsevier Inc. All rights reserved.
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              Definition and delineation of the clinical target volume for rectal cancer.

              Optimization of radiation techniques to maximize local tumor control and to minimize small bowel toxicity in locally advanced rectal cancer requires proper definition and delineation guidelines for the clinical target volume (CTV). The purpose of this investigation was to analyze reported data on the predominant locations and frequency of local recurrences and lymph node involvement in rectal cancer, to propose a definition of the CTV for rectal cancer and guidelines for its delineation. Seven reports were analyzed to assess the incidence and predominant location of local recurrences in rectal cancer. The distribution of lymphatic spread was analyzed in another 10 reports to record the relative frequency and location of metastatic lymph nodes in rectal cancer, according to the stage and level of the primary tumor. The mesorectal, posterior, and inferior pelvic subsites are most at risk for local recurrences, whereas lymphatic tumor spread occurs mainly in three directions: upward into the inferior mesenteric nodes; lateral into the internal iliac lymph nodes; and, in a few cases, downward into the external iliac and inguinal lymph nodes. The risk for recurrence or lymph node involvement is related to the stage and the level of the primary lesion. Based on a review of articles reporting on the incidence and predominant location of local recurrences and the distribution of lymphatic spread in rectal cancer, we defined guidelines for CTV delineation including the pelvic subsites and lymph node groups at risk for microscopic involvement. We propose to include the primary tumor, the mesorectal subsite, and the posterior pelvic subsite in the CTV in all patients. Moreover, the lateral lymph nodes are at high risk for microscopic involvement and should also be added in the CTV.

                Author and article information

                Impact Journals LLC
                5 July 2016
                10 June 2016
                : 7
                : 27
                : 42579-42584
                1 Department of Radiation Oncology, Sacred Heart Catholic University of Rome, Rome, Italy
                2 Varian Medical Systems, Product Manager, Clinical Solutions, Palo Alto, CA, USA
                3 Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
                Author notes
                Correspondence to: Chiara Valentini, chiara.valentini83@ 123456gmail.com
                Copyright: © 2016 Gambacorta et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                : 11 January 2016
                : 17 May 2016
                Research Paper

                Oncology & Radiotherapy
                automatic delineation software,rectal cancer,rectal cancer delineation,independent check,clinical use of automatic delineation software


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