Related Experiment Video
Updated: Nov 9, 2025

Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
Published on: May 10, 2021
Method of computing direction-dependent margins for the development of consensus contouring guidelines
Liam S P Lawrence1, Lee C L Chin2,3, Rachel W Chan4
1Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
Background:
Clinical target volume (CTV) contouring guidelines are frequently developed through studies in which experts contour the CTV for a representative set of cases for a given treatment site and the consensus CTVs are analyzed to generate margin recommendations. Measures of interobserver variability are used to quantify agreement between experts. In cases where an isotropic margin is not appropriate, however, there is no standard method to compute margins in specified directions that represent possible routes of tumor spread. Moreover, interobserver variability metrics are often measures of volume overlap that do not account for the dependence of disagreement on direction. To aid in the development of consensus contouring guidelines, this study demonstrates a novel method of quantifying CTV margins and interobserver variability in clinician-specified directions.
Methods:
The proposed algorithm was applied to 11 cases of non-spine bone metastases to compute the consensus CTV margin in each direction of intraosseous and extraosseous disease. The median over all cases for each route of spread yielded the recommended margins. The disagreement between experts on the CTV margin was quantified by computing the median of the coefficients of variation for intraosseous and extraosseous margins.
Results:
The recommended intraosseous and extraosseous margins were 7.0 mm and 8.0 mm, respectively. The median coefficient of variation quantifying the margin disagreement between experts was 0.59 and 0.48 for intraosseous and extraosseous disease.
Conclusions:
The proposed algorithm permits the generation of margin recommendations in relation to adjacent anatomy and quantifies interobserver variability in specified directions. This method can be applied to future consensus CTV contouring studies.
Related Concept Videos
Design Example: Marking Boundaries of a Site Using a Compass
Topographic Surveying and Contours
Methods of Obtaining Topography
Area Computation by the Alternative Coordinate Method
Latitudes and Departures
Design Example: Analyzing Capacity Contours for Flood Risk Assessment

