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Abstract：
BACKGROUND: The planification of radiation therapy (RT) for pancreatic cancer (PC) requires a dosimetric computed tomography (CT) scan to define the gross tumor volume (GTV). The main objective of this study was to compare the inter-observer variability in RT planning between the arterial and the venous phases following intravenous contrast.
METHODS: PANCRINJ was a prospective monocentric study that included twenty patients with non-metastatic PC. Patients underwent a pre-therapeutic CT scan at the arterial and venous phases. The delineation of the GTV was performed by one radiologist (gold standard) and two senior radiation oncologists (operators). The primary objective was to compare the Jaccard conformity index (JCI) for the GTVs computed between the GS (gold standard) and the operators between the arterial and the venous phases with a Wilcoxon signed rank test for paired samples. The secondary endpoints were the geographical miss index (GMI), the kappa index, the intra-operator variability, and the dose-volume histograms between the arterial and venous phases.
RESULTS: The median JCI for the arterial and venous phases were 0.50 (range, 0.17-0.64) and 0.41 (range, 0.23-0.61) (p = 0.10) respectively. The median GS-GTV was statistically significantly smaller compared to the operators at the arterial (p < 0.0001) and venous phases (p < 0.001), respectively. The GMI were low with few tumors missed for all patients with a median GMI of 0.07 (range, 0-0.79) and 0.05 (range, 0-0.39) at the arterial and venous phases, respectively (p = 0.15). There was a moderate agreement between the radiation oncologists with a median kappa index of 0.52 (range 0.38-0.57) on the arterial phase, and 0.52 (range 0.36-0.57) on the venous phase (p = 0.08). The intra-observer variability for GTV delineation was lower at the venous phase than at the arterial phase for the two operators. There was no significant difference between the arterial and the venous phases regarding the dose-volume histogram for the operators.
CONCLUSIONS: Our results showed inter- and intra-observer variability in delineating GTV for PC without significant differences between the arterial and the venous phases. The use of both phases should be encouraged. Our findings suggest the need to provide training for radiation oncologists in pancreatic imaging and to collaborate within a multidisciplinary team.
METHODS: PANCRINJ was a prospective monocentric study that included twenty patients with non-metastatic PC. Patients underwent a pre-therapeutic CT scan at the arterial and venous phases. The delineation of the GTV was performed by one radiologist (gold standard) and two senior radiation oncologists (operators). The primary objective was to compare the Jaccard conformity index (JCI) for the GTVs computed between the GS (gold standard) and the operators between the arterial and the venous phases with a Wilcoxon signed rank test for paired samples. The secondary endpoints were the geographical miss index (GMI), the kappa index, the intra-operator variability, and the dose-volume histograms between the arterial and venous phases.
RESULTS: The median JCI for the arterial and venous phases were 0.50 (range, 0.17-0.64) and 0.41 (range, 0.23-0.61) (p = 0.10) respectively. The median GS-GTV was statistically significantly smaller compared to the operators at the arterial (p < 0.0001) and venous phases (p < 0.001), respectively. The GMI were low with few tumors missed for all patients with a median GMI of 0.07 (range, 0-0.79) and 0.05 (range, 0-0.39) at the arterial and venous phases, respectively (p = 0.15). There was a moderate agreement between the radiation oncologists with a median kappa index of 0.52 (range 0.38-0.57) on the arterial phase, and 0.52 (range 0.36-0.57) on the venous phase (p = 0.08). The intra-observer variability for GTV delineation was lower at the venous phase than at the arterial phase for the two operators. There was no significant difference between the arterial and the venous phases regarding the dose-volume histogram for the operators.
CONCLUSIONS: Our results showed inter- and intra-observer variability in delineating GTV for PC without significant differences between the arterial and the venous phases. The use of both phases should be encouraged. Our findings suggest the need to provide training for radiation oncologists in pancreatic imaging and to collaborate within a multidisciplinary team.
摘要：
背景：胰腺癌（PC）的放射治疗（RT）的平面化需要剂量学计算机断层扫描（CT）扫描来定义大体肿瘤体积（GTV）。这项研究的主要目的是比较静脉造影后动脉和静脉阶段之间RT计划的观察者间差异。
方法：PANCRINJ是一项前瞻性单中心研究，包括20例非转移性PC患者。患者在动脉和静脉阶段接受了治疗前CT扫描。GTV的轮廓由一名放射科医师（黄金标准）和两名高级放射肿瘤学家（操作员）进行。主要目的是比较在GS（金标准）和操作者之间在动脉和静脉阶段之间计算的GTV的Jaccard一致性指数（JCI），并对配对样本进行Wilcoxon符号秩检验。次要终点是地理错过指数(GMI)，kappa指数,操作者内部的可变性，以及动脉和静脉阶段之间的剂量-体积直方图。
结果：动脉和静脉期的JCI中位数为0.50（范围，0.17-0.64)和0.41(范围，0.23-0.61)(p=0.10)。在动脉期（p<0.0001）和静脉期（p<0.001），与操作员相比，GS-GTV中位数在统计学上明显较小。分别。GMI较低，所有患者的GMI中位数为0.07（范围，0-0.79)和0.05(范围，0-0.39）在动脉和静脉阶段，分别（p=0.15）。放射肿瘤学家之间在动脉期的中位数kappa指数为0.52（范围为0.38-0.57）之间有适度的一致性，静脉相为0.52（范围为0.36-0.57）（p=0.08）。对于两名操作员，GTV描绘的观察者内部变异性在静脉阶段低于动脉阶段。关于操作员的剂量-体积直方图，动脉期和静脉期之间没有显着差异。
结论：我们的结果表明，在描绘PC的GTV时，观察者之间和观察者之间的差异没有显着差异。应鼓励使用这两个阶段。我们的研究结果表明，有必要为放射肿瘤学家提供胰腺成像方面的培训，并在多学科团队中进行合作。
方法：PANCRINJ是一项前瞻性单中心研究，包括20例非转移性PC患者。患者在动脉和静脉阶段接受了治疗前CT扫描。GTV的轮廓由一名放射科医师（黄金标准）和两名高级放射肿瘤学家（操作员）进行。主要目的是比较在GS（金标准）和操作者之间在动脉和静脉阶段之间计算的GTV的Jaccard一致性指数（JCI），并对配对样本进行Wilcoxon符号秩检验。次要终点是地理错过指数(GMI)，kappa指数,操作者内部的可变性，以及动脉和静脉阶段之间的剂量-体积直方图。
结果：动脉和静脉期的JCI中位数为0.50（范围，0.17-0.64)和0.41(范围，0.23-0.61)(p=0.10)。在动脉期（p<0.0001）和静脉期（p<0.001），与操作员相比，GS-GTV中位数在统计学上明显较小。分别。GMI较低，所有患者的GMI中位数为0.07（范围，0-0.79)和0.05(范围，0-0.39）在动脉和静脉阶段，分别（p=0.15）。放射肿瘤学家之间在动脉期的中位数kappa指数为0.52（范围为0.38-0.57）之间有适度的一致性，静脉相为0.52（范围为0.36-0.57）（p=0.08）。对于两名操作员，GTV描绘的观察者内部变异性在静脉阶段低于动脉阶段。关于操作员的剂量-体积直方图，动脉期和静脉期之间没有显着差异。
结论：我们的结果表明，在描绘PC的GTV时，观察者之间和观察者之间的差异没有显着差异。应鼓励使用这两个阶段。我们的研究结果表明，有必要为放射肿瘤学家提供胰腺成像方面的培训，并在多学科团队中进行合作。
