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Human-computer interaction in radiotherapy target volume delineation: a prospective, multi-institutional comparison of user input devices.

ABSTRACT: The purpose of this study was the prospective comparison of objective and subjective effects of target volume region of interest (ROI) delineation using mouse-keyboard and pen-tablet user input devices (UIDs). The study was designed as a prospective test/retest sequence, with Wilcoxon signed rank test for matched-pair comparison. Twenty-one physician-observers contoured target volume ROIs on four standardized cases (representative of brain, prostate, lung, and head and neck malignancies) twice: once using QWERTY keyboard/scroll-wheel mouse UID and once with pen-tablet UID (DTX2100, Wacom Technology Corporation, Vancouver, WA, USA). Active task time, ROI manipulation task data, and subjective survey data were collected. One hundred twenty-nine target volume ROI sets were collected, with 62 paired pen-tablet/mouse-keyboard sessions. Active contouring time was reduced using the pen-tablet UID, with mean ± SD active contouring time of 26?±?23 min, compared with 32?±?25 with the mouse (p???0.01). Subjective estimation of time spent was also reduced from 31?±?26 with mouse to 27?±?22 min with the pen (p?=?0.02). Task analysis showed ROI correction task reduction (p?=?0.045) and decreased panning and scrolling tasks (p?

SUBMITTER: Multi-Institutional Target Delineation in Oncology Group

PROVIDER: S-EPMC3180541 | biostudies-literature | 2011 Oct

REPOSITORIES: biostudies-literature

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Human-computer interaction in radiotherapy target volume delineation: a prospective, multi-institutional comparison of user input devices.

Journal of digital imaging 20111001 5

The purpose of this study was the prospective comparison of objective and subjective effects of target volume region of interest (ROI) delineation using mouse-keyboard and pen-tablet user input devices (UIDs). The study was designed as a prospective test/retest sequence, with Wilcoxon signed rank test for matched-pair comparison. Twenty-one physician-observers contoured target volume ROIs on four standardized cases (representative of brain, prostate, lung, and head and neck malignancies) twice: ...[more]

PMID: 20978922

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Project description:ObjectivesTo determine interobserver variability in axillary nodal contouring in breast cancer (BC) radiotherapy (RT) by comparing the clinical target volume of participating single centres (SC-CTV) with a gold-standard CTV (GS-CTV).MethodsThe GS-CTV of three patients (P1, P2, P3) with increasing complexity was created in DICOM format from the median contour of axillary CTVs drawn by BC experts, validated using the simultaneous truth and performance-level estimation and peer-reviewed. GS-CTVs were compared with the correspondent SC-CTVs drawn by radiation oncologists, using validated metrics and a total score (TS) integrating all of them.ResultsEighteen RT centres participated in the study. Comparative analyses revealed that, on average, the SC-CTVs were smaller than GS-CTV for P1 and P2 (by -29.25% and -27.83%, respectively) and larger for P3 (by +12.53%). The mean Jaccard index was greater for P1 and P2 compared to P3, but the overlap extent value was around 0.50 or less. Regarding nodal levels, L4 showed the highest concordance with the GS. In the intra-patient comparison, L2 and L3 achieved lower TS than L4. Nodal levels showed discrepancy with GS, which was not statistically significant for P1, and negligible for P2, while P3 had the worst agreement. DICE similarity coefficient did not exceed the minimum threshold for agreement of 0.70 in all the measurements.ConclusionsSubstantial differences were observed between SC- and GS-CTV, especially for P3 with altered arm setup. L2 and L3 were the most critical levels. The study highlighted these key points to address.Advances in knowledgeThe present study compares, by means of validated geometric indexes, manual segmentations of axillary lymph nodes in breast cancer from different observers and different institutions made on radiotherapy planning CT images. Assessing such variability is of paramount importance, as geometric uncertainties might lead to incorrect dosimetry and compromise oncological outcome.

Project description:Four-dimensional computed tomography (4D-CT) is commonly used to account for respiratory motion of target volumes in radiotherapy to the thorax. From the 4D-CT acquisition, a maximum-intensity projection (MIP) image set can be created and used to help define the tumor motion envelope or the internal gross tumor volume (iGTV). The purpose of this study was to quantify the differences in automatically contoured target volumes for usage in the delivery of stereotactic body radiation therapy using MIP data sets generated from one of the four methods: (1) 4D-CT phase-binned (PB) based on retrospective phase calculations, (2) 4D-CT phase-corrected phase-binned (PC-PB) based on motion extrema, (3) 4D-CT amplitude-binned (AB), and (4) cine CT built from all available images.MIP image data sets using each of the four methods were generated for a cohort of 28 patients who had prior thoracic 4D-CT scans that exhibited lung tumor motion of at least 1 cm. Each MIP image set was automatically contoured on commercial radiation treatment planning system. Margins were added to the iGTV to observe differences in the final simulated planning target volumes (PTVs).For all patients, the iGTV measured on the MIP generated from the entire cine CT data set (iGTVcine) was the largest. Expressed as a percentage of iGTVcine, 4D-CT iGTV (all sorting methods) ranged from 83.8% to 99.1%, representing differences in the absolute volume ranging from 0.02 to 4.20 cm3; the largest average and range of 4D-CT iGTV measurements was from the PC-PB data set. Expressed as a percentage of PTVcine (expansions applied to iGTVeine), the 4D-CT PTV ranged from 87.6% to 99.6%, representing differences in the absolute volume ranging from 0.08 to 7.42 cm3. Regions of the measured respiratory waveform corresponding to a rapid change of phase or amplitude showed an increased susceptibility to the selection of identical images for adjacent bins. Duplicate image selection was most common in the AB implementation, followed by the PC-PB method. The authors also found that the image associated with the minimum amplitude measurement did not always correlate with the image that showed maximum tumor motion extent.The authors identified cases in which the MIP generated from a 4D-CT sorting process under-represented the iGTV by more than 10% or up to 4.2 cm3 when compared to the iGTVcine. They suggest utilization of a MIP generated from the full cine CT data set to ensure maximum inclusive tumor extent.

Dataset Information

Human-computer interaction in radiotherapy target volume delineation: a prospective, multi-institutional comparison of user input devices.

Publications

Human-computer interaction in radiotherapy target volume delineation: a prospective, multi-institutional comparison of user input devices.

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