Authors:	Stockinger, Marcus Karle, Heiko Rennau, Hannes Sebb, Sabine Wolf, Ulrich Remmele, Julia Bührdel, Sandra Bartkowiak, Detlef Blettner, Maria Schmidberger, Heinz Wollschläger, Daniel
Title:	Heart atlas for retrospective cardiac dosimetry : a multi-institutional study on interobserver contouring variations and their dosimetric impact
Online publication date:	22-Aug-2022
Year of first publication:	2021
Language:	english
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.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-7592
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	Radiation oncology 16
Pages or article number:	241
Publisher:	BioMed Central
Publisher place:	London
Issue date:	2021
ISSN:	1748-717X
Publisher DOI:	10.1186/s13014-021-01965-5
Appears in collections:	JGU-Publikationen