[1]陈美宁,刘懿梅,彭应林,等.不同级别肿瘤中心医师对鼻咽癌调强放疗靶区和危及器官勾画差异比较[J].中国医学物理学杂志,2024,41(3):265-272.[doi:DOI:10.3969/j.issn.1005-202X.2024.03.001]
　CHEN Meining,LIU Yimei,PENG Yinglin,et al.Comparison of interobserver variations in delineation of target volumes and organs-at-risk for intensity-modulated radiotherapy of nasopharyngeal carcinoma among physicians from different levels of cancer centers[J].Chinese Journal of Medical Physics,2024,41(3):265-272.[doi:DOI:10.3969/j.issn.1005-202X.2024.03.001]
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不同级别肿瘤中心医师对鼻咽癌调强放疗靶区和危及器官勾画差异比较()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第3期
页码:
265-272
栏目:
医学放射物理
出版日期:
2024-03-27

文章信息/Info

Title:
Comparison of interobserver variations in delineation of target volumes and organs-at-risk for intensity-modulated radiotherapy of nasopharyngeal carcinoma among physicians from different levels of cancer centers
文章编号:
1005-202X（2024）03-0265-08
作者:
陈美宁1; 2; 刘懿梅2; 彭应林2; 谢秋英3; 石锦平3; 黄荣3; 赵充2; 邓小武2; 周美娟1
1.南方医科大学公共卫生学院放射医学系/国家药监局化妆品安全评价重点实验室/广东省热带病研究重点实验室， 广东 广州510515； 2.中山大学肿瘤防治中心/华南肿瘤学国家重点实验室/广东省鼻咽癌诊治研究重点实验室， 广东 广州 510060； 3.佛山市第一人民医院放疗科， 广东 佛山 528010
Author(s):
CHEN Meining1; 2;  LIU Yimei2;  PENG Yinglin2;  XIE Qiuying3;  SHI Jinping3;  HUANG Rong3;  ZHAO Chong2;  DENG Xiaowu2;  ZHOU Meijuan1
1. Department of Radiology, School of Public Health, Southern Medical University/Key Laboratory of Cosmetics Safety Evaluation, National Medical Products Administration/Key Laboratory of Tropical Diseases Research, Guangzhou 510515, China 2. Sun Yat-sen University Cancer Center/State Key Laboratory of Oncology in South China/Key Laboratory of Diagnosis and Treatment of Nasopharyngeal Cancer in Guangdong Province, Guangzhou 510060, China 3. Department of Radiation Oncology, the First Peoples Hospital of Foshan, Foshan 528010, China
关键词:
鼻咽癌; 调强放射治疗; 器官勾画; 绝对体积差异; 相似性系数; 离散系数
Keywords:
Keywords: nasopharyngeal carcinoma intensity modulated radiotherapy organ segmentation absolute volume difference ratio Dice similarity coefficient coefficient of variation
分类号:
R739.62
DOI:
DOI:10.3969/j.issn.1005-202X.2024.03.001
文献标志码:
A
摘要:
目的：评估不同级别肿瘤中心医师对鼻咽癌调强放疗计划靶区和危及器官勾画的个体化差异，为多中心放疗临床试验的质量控制提供数据参考。方法：随机抽取12例不同TMN分期的鼻咽癌患者，3名同一市级肿瘤中心医师以手工方式勾画每例患者的靶区（GTVnx）和危及器官（OAR）。以国家区域级肿瘤中心放疗专家手工修改和确认的靶区（GTVnx）和OAR勾画结构作为标准勾画。采用绝对体积差异比（△V_diff）、体积最大/最小比（MMR）、离散系数（CV）和体积相似性指数（DSC）分别比较不同级别肿瘤中心（市级与国家区域级）医师之间和市级肿瘤中心3名医师之间的器官勾画差异，并进一步比较不同级别肿瘤中心医师对不同TMN分期的鼻咽癌放疗计划器官的勾画差异。结果：不同级别肿瘤中心（市级与国家区域级）医师之间勾画GTVnx体积差异明显，3名医生中的最大△V_diff、MMR和CV分别为97.23%±83.45%、2.19±0.75和0.31±0.14，平均DSC<0.7。同时，他们之间对于左右视神经、视交叉、脑垂体等小体积OAR勾画差异也较大，平均MMR>2.8，CV>0.37，DSC<0.51；但对于脑干、脊髓、左右眼球、左右下颌骨等大体积OAR的勾画差异相对较小，平均的△V_diff<42%，MMR<1.55，DSC>0.7。相比于不同级别肿瘤中心医师之间的勾画差异，市级肿瘤中心3名医生勾画差异有一定的减小。另外，不同级别肿瘤中心医师之间对不同分期的鼻咽癌靶区勾画也存在差异，相对早期患者（I或II期）的靶区勾画，他们之间在对晚期患者（III或IV期）靶区勾画的差异更小，平均△V_diff和DSC值分别为（98.31%±67.36% vs 69.38%±72.61%, P<0.05）和（0.55±0.08 vs 0.72±0.12, P<0.05）。结论：不同级别肿瘤中心医师勾画鼻咽癌放疗计划靶区和OAR存在差异，尤其对早期患者靶区（GTVnx）和小体积OAR的勾画。为确保多中心临床试验的准确性，建议对不同级别医师进行统一培训并审核其勾画结果，以减少差异对治疗结果的影响。
Abstract:
Abstract: Objective To assess inter-observer variations (IOV) in the delineation of target volumes and organs-at-risk (OAR) for intensity-modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC) among physicians from different levels of cancer centers, thereby providing a reference for quality control in multi-center clinical trials. Methods Twelve patients with NPC of different TMN stages were randomly selected. Three physicians from the same municipal cancer center manually delineated the target volume (GTVnx) and OAR for each patient. The manually modified and confirmed target volume (GTVnx) and OAR delineation structures by radiotherapy experts from the regional cancer center were used as the standard delineation. The absolute volume difference ratio (△V_diff), maximum/minimum volume ratio (MMR), coefficient of variation (CV), and Dice similarity coefficient (DSC) were used to compare the differences in organ delineation among physicians from different levels of cancer centers and among the 3 physicians from the same municipal cancer center. Furthermore, the IOV of GTVnx and OAR among physicians from different levels cancer centers were compared across different TMN stages. Results Significant differences in the delineation of GTVnx were observed among physicians from different levels of cancer centers. Among the 3 physicians, the maximum values of △V_diff, MMR, and CV were 97.23%±83.45%, 2.19±0.75, and 0.31±0.14, respectively, with an average DSC of less than 0.7. Additionally, there were considerable differences in the delineation of small-volume OAR such as the left and right optic nerves, chiasm, and pituitary, with average MMR>2.8, CV>0.37, and DSC<0.51. However, relatively smaller differences were observed in the delineation of large-volume OAR such as the brainstem, spinal cord, left and right eyeballs, and left and right mandible, with average △V_diff<42%, MMR<1.55, and DSC>0.7. Compared with the differences among physicians from different levels cancer centers, the differences among the 3 physicians from the municipal cancer center were slightly reduced. Furthermore, there were also differences in the delineation of target volumes for NPC among physicians from different levels cancer centers, depending on the staging of the disease. Compared with the delineation of target volumes for earlier stage patients (stages I or II), the differences among physicians in the delineation of target volumes for advanced stage patients (stages III or IV) were smaller, with average △V_diff and DSC of 98.31%±67.36% vs 69.38%±72.61% (P<0.05) and 0.55±0.08 vs 0.72±0.12 (P<0.05), respectively. Conclusion There are differences in the delineation of GTVnx and OAR in radiation therapy for NPC among physicians from different levels of cancer centers, especially in the delineation of target volume (GTVnx) and small-volume OAR for early-stage patients. To ensure the accuracy of multicenter clinical trials, it is recommended to provide unified training to physicians from different levels of cancer centers and review their delineation results to reduce the effect of differences on treatment outcomes.

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备注/Memo

备注/Memo:
【收稿日期】2023-10-21 【基金项目】国家重点研发计划（2022YFC2402304）；国家自然科学基金（12005316）；广州市科技计划项目（202206010154, 202206010180） 【作者简介】陈美宁，初级技师，研究方向：肿瘤放射治疗物理学，E-mail: chenmn1@sysucc.org.cn 【通信作者】周美娟，博士，教授，研究方向：放射生物学，E-mail: 80758598@qq.com
更新日期/Last Update: 2024-04-08