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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 2.5mm. The mean dose (D-mean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D-1%) 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 D-mean constraint was not violated.
Keywords
SCLC, HA-PCI, Hippocampus delineation, Inter-observer variation, CELL LUNG-CANCER, QUALITY-OF-LIFE, WHOLE-BRAIN RADIOTHERAPY, MANUAL SEGMENTATION, AUTOMATIC SEGMENTATION, ALZHEIMERS-DISEASE, RTOG 0212, RADIATION, METASTASES, TRIAL

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MLA
Bartel, F., et al. “Inter-Observer Variation of Hippocampus Delineation in Hippocampal Avoidance Prophylactic Cranial Irradiation.” CLINICAL & TRANSLATIONAL ONCOLOGY, vol. 21, no. 2, 2019, pp. 178–86.
APA
Bartel, F., van Herk, M., Vrenken, H., Vandaele, F., Sunaert, S., de Jaeger, K., … Belderbos, J. (2019). Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation. CLINICAL & TRANSLATIONAL ONCOLOGY, 21(2), 178–186.
Chicago author-date
Bartel, F, M van Herk, H Vrenken, F Vandaele, S Sunaert, K de Jaeger, NJ Dollekamp, et al. 2019. “Inter-Observer Variation of Hippocampus Delineation in Hippocampal Avoidance Prophylactic Cranial Irradiation.” CLINICAL & TRANSLATIONAL ONCOLOGY 21 (2): 178–86.
Chicago author-date (all authors)
Bartel, F, M van Herk, H Vrenken, F Vandaele, S Sunaert, K de Jaeger, NJ Dollekamp, C Carbaat, E Lamers, EMT Dieleman, Yolande Lievens, D de Ruysscher, SB Schagen, MB de Ruiter, JC de Munck, and J Belderbos. 2019. “Inter-Observer Variation of Hippocampus Delineation in Hippocampal Avoidance Prophylactic Cranial Irradiation.” CLINICAL & TRANSLATIONAL ONCOLOGY 21 (2): 178–186.
Vancouver
1.
Bartel F, van Herk M, Vrenken H, Vandaele F, Sunaert S, de Jaeger K, et al. Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation. CLINICAL & TRANSLATIONAL ONCOLOGY. 2019;21(2):178–86.
IEEE
[1]
F. Bartel et al., “Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation,” CLINICAL & TRANSLATIONAL ONCOLOGY, vol. 21, no. 2, pp. 178–186, 2019.
@article{8568082,
  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 2.5mm. The mean dose (D-mean) constraint was met for all delineations, but for the dose received by 1% of the hippocampal volume (D-1%) 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 D-mean constraint was not violated.},
  author       = {Bartel, F and van Herk, M and Vrenken, H and Vandaele, F and Sunaert, S and de Jaeger, K and Dollekamp, NJ and Carbaat, C and Lamers, E and Dieleman, EMT and Lievens, Yolande and de Ruysscher, D and Schagen, SB and de Ruiter, MB and de Munck, JC and Belderbos, J},
  issn         = {1699-048X},
  journal      = {CLINICAL & TRANSLATIONAL ONCOLOGY},
  keywords     = {SCLC,HA-PCI,Hippocampus delineation,Inter-observer variation,CELL LUNG-CANCER,QUALITY-OF-LIFE,WHOLE-BRAIN RADIOTHERAPY,MANUAL SEGMENTATION,AUTOMATIC SEGMENTATION,ALZHEIMERS-DISEASE,RTOG 0212,RADIATION,METASTASES,TRIAL},
  language     = {eng},
  number       = {2},
  pages        = {178--186},
  title        = {Inter-observer variation of hippocampus delineation in hippocampal avoidance prophylactic cranial irradiation},
  url          = {http://dx.doi.org/10.1007/s12094-018-1903-7},
  volume       = {21},
  year         = {2019},
}

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