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Multiple training interventions significantly improve reproducibility of PET/CT-based lung cancer radiotherapy target
Tom Konert1, Wouter V Vogel1, Sarah Everitt2
1Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Background And Purpose:
To assess the impact of a standardized delineation protocol and training interventions on PET/CT-based target volume delineation (TVD) in NSCLC in a multicenter setting.
Material And Methods:
Over a one-year period, 11 pairs, comprised each of a radiation oncologist and nuclear medicine physician with limited experience in PET/CT-based TVD for NSCLC from nine different countries took part in a training program through an International Atomic Energy Agency (IAEA) study (NCT02247713). Teams delineated gross tumor volume of the primary tumor, during and after training interventions, according to a provided delineation protocol. In-house developed software recorded the performed delineations, to allow visual inspection of strategies and to assess delineation accuracy.
Results:
Following the first training, overall concordance indices for 3 repetitive cases increased from 0.57±0.07 to 0.66±0.07. The overall mean surface distance between observer and expert contours decreased from -0.40±0.03cm to -0.01±0.33cm. After further training overall concordance indices for another 3 repetitive cases further increased from 0.64±0.06 to 0.80±0.05 (p=0.01). Mean surface distances decreased from -0.34±0.16cm to -0.05±0.20cm (p=0.01).
Conclusion:
Multiple training interventions improve PET/CT-based TVD delineation accuracy in NSCLC and reduce interobserver variation.