Validation of separate multi-atlases for auto segmentation of cardiac substructures in CT-scans acquired in deep inspiration breath hold and free breathing

Daan S. Spoor, Nanna M. Sijtsema*, Veerle A. B. van den Bogaard, Arjen van der Schaaf, Charlotte L. Brouwer, Bastiaan D. P. Ta, Rozemarijn Vliegenthart, Roel G. J. Kierkels, Johannes A. Langendijk, John H. Maduro, Femke B. J. Peters, Anne P. G. Crijns

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Background and purpose: Developing NTCP-models for cardiac complications after breast cancer (BC) radiotherapy requires cardiac dose-volume parameters for many patients. These can be obtained by using multi-atlas based automatic segmentation (MABAS) of cardiac structures in planning CT scans. We investigated the relevance of separate multi-atlases for deep inspiration breath hold (DIBH) and free breathing (FB) CT scans.

Materials and methods: BC patients scanned in DIBH (n = 10) and in FB (n = 20) were selected to create separate multi-atlases consisting of expert panel delineations of the whole heart, atria and ventricles. The accuracy of atlas-generated contours was validated with expert delineations in independent datasets (n = 10 for DIBH and FB) and reported as Dice coefficients, contour distances and dose-volume differences in relation to interobserver variability of manual contours. Dependency of MABAS contouring accuracy on breathing technique was assessed by validation of a FB atlas in DIBH patients and vice versa (cross validation).

Results: For all structures the FB and DIBH atlases resulted in Dice coefficients with their respective reference contours > 0.8 and average contour distances < 2 mm smaller than slice thickness of (CTs). No significant differences were found for dose-volume parameters in volumes receiving relevant dose levels (WH, LV and RV). Accuracy of the DIBH atlas was at least similar to, and for the ventricles better than, the interobserver variation in manual delineation. Cross-validation between breathing techniques showed a reduced MABAS performance.

Conclusion: Multi-atlas accuracy was at least similar to interobserver delineation variation. Separate atlases for scans made in DIBH and FB could benefit atlas performance because accuracy depends on breathing technique.

Original languageEnglish
Pages (from-to)46-54
Number of pages9
JournalRadiotherapy and Oncology
Volume163
DOIs
Publication statusPublished - Oct-2021

Keywords

  • Breast cancer
  • Cardiac contouring
  • Multi-atlas based automatic segmentation
  • Deep inspiration breath hold
  • DESCENDING CORONARY-ARTERY
  • CANCER PATIENTS
  • AUTOMATIC SEGMENTATION
  • RADIATION-THERAPY
  • HEART
  • RADIOTHERAPY
  • DELINEATION
  • RISK
  • REPRODUCIBILITY
  • EXPOSURE

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