PMID- 16421504
OWN - NLM
STAT- MEDLINE
DCOM- 20060331
LR  - 20190513
IS  - 1526-9914 (Electronic)
IS  - 1526-9914 (Linking)
VI  - 6
IP  - 4
DP  - 2005 Fall
TI  - Interobserver variation in cervical cancer tumor delineation for image-based 
      radiotherapy planning among and within different specialties.
PG  - 106-10
AB  - Radiation therapy for cervical cancer involves a team of specialists, including 
      diagnostic radiologists (DRs), radiation oncologists (ROs), and medical 
      physicists (MPs), to optimize imaging-based radiation therapy planning. The 
      purpose of the study was to investigate the interobserver variations in tumor 
      delineation on MR images of cervical cancer within the same and among different 
      specialties. Twenty MRI cervical cancer studies were independently reviewed by 
      two DRs, two ROs, and two MPs. For every study, each specialist contoured the 
      tumor regions of interest (ROIs) on T2-weighted Turbo Spin Echo sagittal images 
      on all slices containing tumor, and the total tumor volume was computed for 
      statistical analysis. Analysis of variance (ANOVA) was used to compare the 
      differences in tumor volume delineation among the observers. A graph of all 
      tumor-delineated volumes was generated, and differences between the maximum and 
      minimum volumes over all the readers for each patient dataset were computed. 
      Challenges during the evaluation process for tumor delineation were recorded for 
      each specialist. Interobserver variations of delineated tumor volumes were 
      significant (p < 0.01) among all observers based on a repeated measures ANOVA, 
      which produced an F(5,95) = 3.55. The median difference between the maximum 
      delineated volume and minimum delineated volume was 33.5 cm3 (which can be 
      approximated by a sphere of 4.0 cm diameter) across all 20 patients. Challenges 
      noted for tumor delineation included the following: (1) partial voluming by 
      parametrial fat at the periphery of the uterus; (2) extension of the tumor into 
      parametrial space; (3) similar signal intensity of structures proximal to the 
      tumor such as ovaries, muscles, bladder wall, bowel loops, and pubic symphysis; 
      (4) postradiation changes such as heterogeneity and necrosis; (5) susceptibility 
      artifacts from bowels and vaginal tampons; (6) presence of other pathologies such 
      as atypical myoma; (7) factors that affect pelvic anatomy, including the degree 
      of bladder distension, bowel interposition, uterine malposition, retroversion, 
      and descensus. Our limited study indicates significant interobserver variation in 
      tumor delineation. Despite rapid progress in technology, which has improved the 
      resolution and precision of image acquisition and the delivery of radiotherapy to 
      the millimeter level, such "human" variations (at the centimeter level) may 
      overshadow the gain from technical advancement and impact treatment planning. 
      Strategies of standardization and training in tumor delineation need to be 
      developed.
FAU - Wu, Dee H
AU  - Wu DH
AD  - Radiological Sciences, University of Oklahoma, Oklahoma City, Oklahoma, USA. 
      dee-wu@ouhsc.edu
FAU - Mayr, Nina A
AU  - Mayr NA
FAU - Karatas, Yasemin
AU  - Karatas Y
FAU - Karatas, Rifat
AU  - Karatas R
FAU - Adli, Mustafa
AU  - Adli M
FAU - Edwards, Susan M
AU  - Edwards SM
FAU - Wolff, James D
AU  - Wolff JD
FAU - Movahed, Allen
AU  - Movahed A
FAU - Montebello, Joseph F
AU  - Montebello JF
FAU - Yuh, William T C
AU  - Yuh WT
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20051121
PL  - United States
TA  - J Appl Clin Med Phys
JT  - Journal of applied clinical medical physics
JID - 101089176
SB  - IM
MH  - Female
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - *Medicine
MH  - Observer Variation
MH  - *Professional Competence
MH  - Quality Assurance, Health Care/*methods
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - *Specialization
MH  - Uterine Cervical Neoplasms/*pathology/*radiotherapy
PMC - PMC5723451
EDAT- 2006/01/20 09:00
MHDA- 2006/04/01 09:00
PMCR- 2005/11/22
CRDT- 2006/01/20 09:00
PHST- 2006/01/20 09:00 [pubmed]
PHST- 2006/04/01 09:00 [medline]
PHST- 2006/01/20 09:00 [entrez]
PHST- 2005/11/22 00:00 [pmc-release]
AID - ACM20106 [pii]
AID - 10.1120/jacmp.v6i4.2117 [doi]
PST - ppublish
SO  - J Appl Clin Med Phys. 2005 Fall;6(4):106-10. doi: 10.1120/jacmp.v6i4.2117. Epub 
      2005 Nov 21.