目的：在复发性室性心动过速（VT）患者中，急性定向心律失常放射性消融（STAR）显示了有希望的结果。STOPSTORM联盟的成立是为了调查和协调欧洲的STAR治疗。这项基准研究的主要目标是标准化STAR的风险器官（OAR）轮廓，包括心脏的详细结构，并认可每个参与中心。
方法：STOPSTORM联盟的中心被要求在三个STAR案例中描述31个OAR。联盟专家小组审查了划定，并在向所有参与者提供了专门的研讨会反馈和认证之后。通过计算DICE相似系数（DSC）进行了进一步的定量分析，中位数协议距离(MDA)，和95百分位数到协议的距离(HD95)。
结果：20个中心参与了这项研究。基于DSC,MDA和HD95，众所周知的OAR在放疗中的轮廓相似，例如肺（中位DSC=0.96，中位MDA=0.1mm，中位HD95=1.1mm）和主动脉（中位DSC=0.90，中位MDA=0.1mm，中位HD95=1.5mm）。一些中心不包括胃食管交界处，导致胃和食道轮廓的差异。对于心脏亚结构，如腔室(DSC中位数=0.83，MDA中位数=0.2mm，HD95中位数=0.5mm)，瓣膜（DSC中位数=0.16，MDA中位数=4.6mm，HD95中位数=16.0mm），冠状动脉（中位DSC=0.4，中位MDA=0.7mm，中位HD95=8.3mm）以及窦房和房室结（中位DSC=0.29，中位MDA=4.4mm，中位HD95=11.4mm），中心之间的偏差发生得更频繁。在专门的讲习班之后，所有中心都获得了认可，并建立了STAR轮廓共识准则。
结论：这项STOPSTORM多中心关键结构轮廓基准研究显示了标准放射治疗OAR的高度一致性。然而,对于心脏子结构，轮廓出现较大的分歧，这可能对STAR治疗计划和剂量学评估产生重大影响。为了标准化OAR轮廓，建立了STAR中关键结构轮廓的共识准则。
In patients with recurrent ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) shows promising results. The STOPSTORM.eu consortium was established to investigate and harmonise STAR treatment in Europe. The primary goals of this benchmark study were to standardise contouring of organs at risk (OAR) for STAR, including detailed substructures of the heart, and accredit each participating centre.
Centres within the STOPSTORM.eu consortium were asked to delineate 31 OAR in three STAR cases. Delineation was reviewed by the consortium expert panel and after a dedicated workshop feedback and accreditation was provided to all participants. Further quantitative analysis was performed by calculating DICE similarity coefficients (DSC), median distance to agreement (MDA), and 95th percentile distance to agreement (HD95).
Twenty centres participated in this study. Based on DSC, MDA and HD95, the delineations of well-known OAR in radiotherapy were similar, such as lungs (median DSC = 0.96, median MDA = 0.1 mm and median HD95 = 1.1 mm) and aorta (median DSC = 0.90, median MDA = 0.1 mm and median HD95 = 1.5 mm). Some centres did not include the gastro-oesophageal junction, leading to differences in stomach and oesophagus delineations. For cardiac substructures, such as chambers (median DSC = 0.83, median MDA = 0.2 mm and median HD95 = 0.5 mm), valves (median DSC = 0.16, median MDA = 4.6 mm and median HD95 = 16.0 mm), coronary arteries (median DSC = 0.4, median MDA = 0.7 mm and median HD95 = 8.3 mm) and the sinoatrial and atrioventricular nodes (median DSC = 0.29, median MDA = 4.4 mm and median HD95 = 11.4 mm), deviations between centres occurred more frequently. After the dedicated workshop all centres were accredited and contouring
consensus guidelines for STAR were established.
This STOPSTORM multi-centre critical structure contouring benchmark study showed high agreement for standard radiotherapy OAR. However, for cardiac substructures larger disagreement in contouring occurred, which may have significant impact on STAR treatment planning and dosimetry evaluation. To standardize OAR contouring,
consensus guidelines for critical structure contouring in STAR were established.
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