Japanese Journal of Radiology

, Volume 37, Issue 5, pp 420–430 | Cite as

A heart atlas for breast radiation therapy and the influence of delination education on both intra and interobserver variability

  • Meltem KırlıEmail author
  • Doğukan Akçay
  • Mustafa Mahmut Barış
  • İlknur Bilkay Görken
Original Article



We developed a heart atlas for breast radiation therapy and evaluated the influence of education on intra and inter-observer similarity, and cardiac dose reporting.

Materials and methods

The data of 16 left breast cancer patients were analyzed. Eight observers delineated heart and cardiac subunits [left (LCA) and right (RCA) coronary arteries, left anterior descending artery (LAD), bilateral atrium and ventricles] before the education. A radiologist and radiation oncologist developed the atlas and delineated the gold standard (GS) volumes. Observers repeated the delineation after education. RT plans were made for pre/post-atlas contours. The similarity was assessed by Dice (DSC) and Jaccard (JSC) similarity coefficient indices. The absolute difference rate was calculated for the dose analysis.


The inter-observer similarity increased in heart and all subunits. The intra-observer similarity showed a heterogeneous distribution. The absolute difference rate in dose reporting was statistically significant for the bilateral atrium, right ventricle, LAD, LCA + LAD, RCA’s maximum doses (p < 0.05). The maximum dose reporting differences from the GS decreased from 16.9 to 8.9% for LAD (p = 0.011); from 14.8 to 9.3% for LCA + LAD (p = 0.010).


The cardiac atlas reduces the intra-interobserver differences and improves dose reporting consistency. The first intra-observer similarity analysis was made in our study and revealed the need for repeated education to increase the consistency.


Breast radiotherapy Heart atlas Cardiac subunit delineation 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Japan Radiological Society 2019

Authors and Affiliations

  1. 1.Departmant of Radiation OncologyDokuz Eylül University Faculty of MedicineİzmirTurkey
  2. 2.Departmant of RadiologyDokuz Eylül University Faculty of MedicineİzmirTurkey
  3. 3.Department of Radiation OncologyHealth Sciences University Erzurum Regional Training and Research HospitalErzurumTurkey

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