Evaluation of delineating the target volume by radiation therapists in breast cancer patients

Breast radiotherapy accounts for a significant workload in radiotherapy departments. In 2015 it became clinical practice at the Netherlands Cancer Institute for radiation therapists (RTTs) to delineate the clinical target volume of the breast tissue (CTVbreast) and in 2017 axilla level I-II (CTVln12) according to a delineation atlas. All RTTs were trained and got individual feedback. The aim of this retrospective study was to investigate the variation between the CTVbreast with or without CTVln12 delineated by a trained group of radiation therapists and the clinical adjusted delineations by the radiation oncologist/physician assistant (RO/PA), in a large group of patients treated between January 2017 and June 2020.

1012 computer tomography based delineations of CTVbreast and 146 of CTVln12 were collected from January 2017-June 2020. The RTT and RO/PA delineations were compared using the Dice coefficient and the 95th percentile Hausdorff Distance (95%HD). Statistical significance of the differences was tested using a Mann-Whitney test.

Differences in CTVbreast delineations were small. A median Dice score of 1.00 for all years, where 83% of the patients had a Dice score > 0.99. For CTVln12 the magnitude of edits made by RO/PAs decreased over time, with the Dice increasing from a median of 0.87 in 2017 to 0.90 in 2020 (p = 0.031). The 95%HD decreased from a median of 0.93 cm in 2017 to 0.61 cm in 2020 (p = 0.051).

This retrospective study shows that trained dedicated RTTs are capable in delivering the same quality delineations as RO/PAs. The low variability supports the increasing role of RTTs in the contouring process, likely making it more time efficient.