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Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation

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Abstract

Background

Hippocampal avoidance prophylactic cranial irradiation (HA-PCI) techniques have been developed to reduce radiation damage to the hippocampus. An inter-observer hippocampus delineation analysis was performed and the influence of the delineation variability on dose to the hippocampus was studied.

Materials and methods

For five patients, seven observers delineated both hippocampi on brain MRI. The intra-class correlation (ICC) with absolute agreement and the generalized conformity index (CIgen) were computed. Median surfaces over all observers’ delineations were created for each patient and regional outlining differences were analysed. HA-PCI dose plans were made from the median surfaces and we investigated whether dose constraints in the hippocampus could be met for all delineations.

Results

The ICC for the left and right hippocampus was 0.56 and 0.69, respectively, while the CIgen ranged from 0.55 to 0.70. The posterior and anterior-medial hippocampal regions had most variation with SDs ranging from approximately 1 to 2.5 mm. The mean dose (Dmean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D1%) violations were observed.

Conclusion

The relatively low ICC and CIgen indicate that delineation variability among observers for both left and right hippocampus was large. The posterior and anterior-medial border have the largest delineation inaccuracy. The hippocampus Dmean constraint was not violated.

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Acknowledgements

The authors would like to thank C. Chun for her previous work and contribution to this study. This study was funded by ZonMW (Grand Number: 104002006), the Netherlands organisation for health research and development, the Dutch Cancer Society (KWF, Grand Number: 2013-6096) and Netherlands Cancer Institute (NKI) in Amsterdam. We would also like to acknowledge the government agency for Innovation by Science and Technology (A13/TT/1503—IWT/TBM) and NutsOhra (Project 100 3-105).

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

    F. Bartel, H. Vrenken & J. C. de Munck

  2. Department of Cancer Sciences, University of Manchester, Manchester, UK

    M. van Herk

  3. Department of Radiotherapy, Iridium Cancer Network, Antwerp, Belgium

    F. Vandaele

  4. Department of Radiology, University Hospitals Leuven, Louvain, Belgium

    S. Sunaert

  5. Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands

    K. de Jaeger

  6. Department of Radiotherapy, The University Medical Center Groningen, Groningen, The Netherlands

    N. J. Dollekamp

  7. Department of Radiotherapy, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    C. Carbaat, E. Lamers & J. Belderbos

  8. Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands

    E. M. T. Dieleman

  9. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

    Y. Lievens

  10. Department of Radiotherapy, Maastricht University Medical Center, Maastricht, The Netherlands

    D. de Ruysscher

  11. Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    S. B. Schagen & M. B. de Ruiter

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  1. F. Bartel
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Correspondence to J. Belderbos.

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Bartel, F., van Herk, M., Vrenken, H. et al. Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation. Clin Transl Oncol 21, 178–186 (2019). https://doi.org/10.1007/s12094-018-1903-7

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