TY - JOUR
T1 - 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
T2 - Quantitative assessment of conformance to expert delineation
AU - Awan, Musaddiq
AU - Kalpathy-Cramer, Jayashree
AU - Gunn, G. Brandon
AU - Beadle, Beth M.
AU - Garden, Adam S.
AU - Phan, Jack
AU - Holliday, Emma
AU - Jones, William E.
AU - Maani, Elizabeth
AU - Patel, Abhilasha
AU - Choi, Jehee
AU - Clyburn, Virginia
AU - Tantiwongkosi, Bundhit
AU - Rosenthal, David I.
AU - Fuller, Clifton D.
N1 - Funding Information:
Sources of support: Dr Fuller received support from the American Society for Clinical Oncology Conquer Cancer Foundation Young Investigator Award, and the National Institutes of Health Clinician Scientist Loan Repayment Program (L30 CA136381). Dr Kalpathy-Cramer received funding support from a National Institute of Health/National Library of Medicine grant (4R00LM009889). TaCTICS software was developed by Drs Kalpathy-Cramer and Fuller with support from the Society of Imaging Informatics in Medicine (SIIM) Product Development Grant. These funders played no role in the study design, collection, analysis, interpretation of data, manuscript writing, or decision to submit the report for publication.
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/7
Y1 - 2013/7
N2 - 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.
AB - 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.
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U2 - 10.1016/j.prro.2012.11.002
DO - 10.1016/j.prro.2012.11.002
M3 - Article
AN - SCOPUS:84879888975
VL - 3
SP - 186
EP - 193
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
SN - 1879-8500
IS - 3
ER -