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Abstract：
Peer review of head and neck cancer radiation therapy target volumes by radiologists was introduced in our center to optimize target volume delineation. Our aim was to assess the impact of MR imaging-based radiologist peer review of head and neck radiation therapy gross tumor and nodal volumes, through qualitative and quantitative analysis.
Cases undergoing radical radiation therapy with a coregistered MR imaging, between April 2019 and March 2020, were reviewed. The frequency and nature of volume changes were documented, with major changes classified as per the guidance of The Royal College of Radiologists. Volumetric alignment was assessed using the Dice similarity coefficient, Jaccard index, and Hausdorff distance.
Fifty cases were reviewed between April 2019 and March 2020. The median age was 59 years (range, 29-83 years), and 72% were men. Seventy-six percent of gross tumor volumes and 41.5% of gross nodal volumes were altered, with 54.8% of gross tumor volume and 66.6% of gross nodal volume alterations classified as \"major.\" Undercontouring of soft-tissue involvement and unidentified lymph nodes were predominant reasons for change. Radiologist review significantly altered the size of both the gross tumor volume (P = .034) and clinical target tumor volume (P = .003), but not gross nodal volume or clinical target nodal volume. The median conformity and surface distance metrics were the following: gross tumor volume Dice similarity coefficient = 0.93 (range, 0.82-0.96), Jaccard index = 0.87 (range, 0.7-0.94), Hausdorff distance = 7.45 mm (range, 5.6-11.7 mm); and gross nodular tumor volume Dice similarity coefficient = 0.95 (0.91-0.97), Jaccard index = 0.91 (0.83-0.95), and Hausdorff distance = 20.7 mm (range, 12.6-41.6). Conformity improved on gross tumor volume-to-clinical target tumor volume expansion (Dice similarity coefficient = 0.93 versus 0.95, P = .003).
MR imaging-based radiologist review resulted in major changes to most radiotherapy target volumes and significant changes in volume size of both gross tumor volume and clinical target tumor volume, suggesting that this is a fundamental step in the radiotherapy workflow of patients with head and neck cancer.
Cases undergoing radical radiation therapy with a coregistered MR imaging, between April 2019 and March 2020, were reviewed. The frequency and nature of volume changes were documented, with major changes classified as per the guidance of The Royal College of Radiologists. Volumetric alignment was assessed using the Dice similarity coefficient, Jaccard index, and Hausdorff distance.
Fifty cases were reviewed between April 2019 and March 2020. The median age was 59 years (range, 29-83 years), and 72% were men. Seventy-six percent of gross tumor volumes and 41.5% of gross nodal volumes were altered, with 54.8% of gross tumor volume and 66.6% of gross nodal volume alterations classified as \"major.\" Undercontouring of soft-tissue involvement and unidentified lymph nodes were predominant reasons for change. Radiologist review significantly altered the size of both the gross tumor volume (P = .034) and clinical target tumor volume (P = .003), but not gross nodal volume or clinical target nodal volume. The median conformity and surface distance metrics were the following: gross tumor volume Dice similarity coefficient = 0.93 (range, 0.82-0.96), Jaccard index = 0.87 (range, 0.7-0.94), Hausdorff distance = 7.45 mm (range, 5.6-11.7 mm); and gross nodular tumor volume Dice similarity coefficient = 0.95 (0.91-0.97), Jaccard index = 0.91 (0.83-0.95), and Hausdorff distance = 20.7 mm (range, 12.6-41.6). Conformity improved on gross tumor volume-to-clinical target tumor volume expansion (Dice similarity coefficient = 0.93 versus 0.95, P = .003).
MR imaging-based radiologist review resulted in major changes to most radiotherapy target volumes and significant changes in volume size of both gross tumor volume and clinical target tumor volume, suggesting that this is a fundamental step in the radiotherapy workflow of patients with head and neck cancer.
摘要：
目的：我们中心介绍了放射科医师对头颈部肿瘤放射治疗靶区的同行评审，以优化靶区勾画。我们的目的是评估基于MR成像的放射科医师同行评审对头颈部放射治疗的大体肿瘤和淋巴结体积的影响。通过定性和定量分析。
方法：接受根治性放射治疗的病例，在2019年4月至2020年3月期间，进行了审查。记录了体积变化的频率和性质，根据皇家放射科医师学院的指导进行了重大更改。使用骰子相似性系数评估体积比对，Jaccard指数,和Hausdorff距离.
结果：在2019年4月至2020年3月期间对50例病例进行了回顾。平均年龄为59岁(范围，29-83岁），72%是男性。76％的总肿瘤体积和41.5％的总淋巴结体积发生了改变，54.8%的总肿瘤体积和66.6%的总淋巴结体积改变被归类为“主要”。“软组织受累和淋巴结不明是改变的主要原因。放射科医师检查显著改变了肿瘤的大体体积（P=0.034）和临床靶肿瘤体积（P=0.003），但不是总淋巴结体积或临床目标淋巴结体积。中位数一致性和表面距离指标如下：总肿瘤体积Dice相似系数=0.93（范围，0.82-0.96），Jaccard指数=0.87(范围，0.7-0.94），Hausdorff距离=7.45mm(范围,5.6-11.7mm）；总结节肿瘤体积Dice相似系数=0.95（0.91-0.97），Jaccard指数=0.91（0.83-0.95），和Hausdorff距离=20.7mm(范围，12.6-41.6).总体肿瘤体积与临床目标肿瘤体积扩张的一致性得到改善（Dice相似系数=0.93vs.0.95，P=.003）。
结论：基于磁共振成像的放射科医师审查导致大多数放疗靶体积发生重大变化，大体肿瘤体积和临床靶肿瘤体积的体积大小发生显著变化，这表明这是头颈部癌症患者放疗工作流程中的一个基本步骤。
方法：接受根治性放射治疗的病例，在2019年4月至2020年3月期间，进行了审查。记录了体积变化的频率和性质，根据皇家放射科医师学院的指导进行了重大更改。使用骰子相似性系数评估体积比对，Jaccard指数,和Hausdorff距离.
结果：在2019年4月至2020年3月期间对50例病例进行了回顾。平均年龄为59岁(范围，29-83岁），72%是男性。76％的总肿瘤体积和41.5％的总淋巴结体积发生了改变，54.8%的总肿瘤体积和66.6%的总淋巴结体积改变被归类为“主要”。“软组织受累和淋巴结不明是改变的主要原因。放射科医师检查显著改变了肿瘤的大体体积（P=0.034）和临床靶肿瘤体积（P=0.003），但不是总淋巴结体积或临床目标淋巴结体积。中位数一致性和表面距离指标如下：总肿瘤体积Dice相似系数=0.93（范围，0.82-0.96），Jaccard指数=0.87(范围，0.7-0.94），Hausdorff距离=7.45mm(范围,5.6-11.7mm）；总结节肿瘤体积Dice相似系数=0.95（0.91-0.97），Jaccard指数=0.91（0.83-0.95），和Hausdorff距离=20.7mm(范围，12.6-41.6).总体肿瘤体积与临床目标肿瘤体积扩张的一致性得到改善（Dice相似系数=0.93vs.0.95，P=.003）。
结论：基于磁共振成像的放射科医师审查导致大多数放疗靶体积发生重大变化，大体肿瘤体积和临床靶肿瘤体积的体积大小发生显著变化，这表明这是头颈部癌症患者放疗工作流程中的一个基本步骤。
