Prospective assessment of an atlas-based intervention combined with real-time software feedback in contouring lymph node levels and organs-at-risk in the head and neck: Quantitative assessment of conformance to expert delineation

Musaddiq Awan; Jayashree Kalpathy-Cramer; G Brandon Gunn; Beth M Beadle; Adam S Garden; Jack Phan; Emma Holliday; William E Jones 3rd; Elizabeth Maani; Abhilasha Patel; Jehee Choi; Virginia Clyburn; Bundhit Tantiwongkosi; David I Rosenthal; Clifton D Fuller

doi:10.1016/j.prro.2012.11.002

Prospective assessment of an atlas-based intervention combined with real-time software feedback in contouring lymph node levels and organs-at-risk in the head and neck: Quantitative assessment of conformance to expert delineation

Pract Radiat Oncol. 2013 Jul-Sep;3(3):186-193. doi: 10.1016/j.prro.2012.11.002. Epub 2012 Dec 21.

Authors

Affiliations

¹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
² Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Harvard Medical School, Charlestown, Massachusetts; Department of Radiology and Neuroscience, Massachusetts General Hospital, Charlestown, Massachusetts; Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon.
³ South Texas Veterans Affairs Health Care System, San Antonio, Texas; Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
⁴ Department of Radiation Oncology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
⁵ Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
⁶ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon. Electronic address: cdfuller@mdanderson.org.

Abstract

Purpose: A number of studies have previously assessed the role of teaching interventions to improve organ-at-risk (OAR) delineation. We present a preliminary study demonstrating the benefit of a combined atlas and real time software-based feedback intervention to aid in contouring of OARs in the head and neck.

Methods and materials: The study consisted of a baseline evaluation, a real-time feedback intervention, atlas presentation, and a follow-up evaluation. At baseline evaluation, 8 resident observers contoured 26 OARs on a computed tomography scan without intervention or aid. They then received feedback comparing their contours both statistically and graphically to a set of atlas-based expert contours. Additionally, they received access to an atlas to contour these structures. The resident observers were then asked to contour the same 26 OARs on a separate computed tomography scan with atlas access. In addition, 6 experts (5 radiation oncologists specializing in the head and neck, and 1 neuroradiologist) contoured the 26 OARs on both scans. A simultaneous truth and performance level estimation (STAPLE) composite of the expert contours was used as a gold-standard set for analysis of OAR contouring.

Results: Of the 8 resident observers who initially participated in the study, 7 completed both phases of the study. Dice similarity coefficients were calculated for each user-drawn structure relative to the expert STAPLE composite for each structure. Mean dice similarity coefficients across all structures increased between phase 1 and phase 2 for each resident observer, demonstrating a statistically significant improvement in overall OAR-contouring ability (P < .01). Additionally, intervention improved contouring in 16/26 delineated organs-at-risk across resident observers at a statistically significant level (P ≤ .05) including all otic structures and suprahyoid lymph node levels of the head and neck.

Conclusions: Our data suggest that a combined atlas and real-time feedback-based educational intervention detectably improves contouring of OARs in the head and neck.

Abstract

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