![N°of
pts
Evaluated
districts
Anatomical
charactaristics
considered
10
Pelvic nodal
volumes in
endometrial
cancer adj
therapy
Anteroposterior
and lateral
separation.
BMI not available
for all pts
9 (per
Adjuvant
Brest cancer
Breast size
6
Anorectal
cancer
Gender and
location of tumor
5
H&N nodal
level and OAR
Young et al,
Int. J. Radiation
Oncology Biol.
Phys., Vol. 79, No. 3,
pp. 943–947, 2011
Anders et al,
Radiotherapy and
Oncology 102
(2012) 68–73
group)
Teguh et al,
Int. J. Radiation
Oncology Biol. Phys.,
Vol. 81, No. 4, pp.
950–957, 2011
Gambacorta
et al,
10
Acta Oncol. 2013
Jan 22. [Epub ahead
of print]
Pelvic lymph
nodes in
locally
advanced
rectal cancer
Mean Dice
coefficient
0.8
Spared
time
26%
(p<0.000001)
-
0.79-0.85
-
0.67-0.79
Sex, age, weight, height,
BMI, menopausal state,
sacro-cocciegeal
distance, most anterior
distance between upper
iliac crests
0.86-0.91
56%
0.70
25-34%](https://image.slidesharecdn.com/dice-corso27-131015031547-phpapp01/85/Dice-corso_27-02-80-320.jpg)
Uploaded byGemelli Advanced Radiation Therapy
Dice corso_27.02
• Creation of 1 ATLAS based on 15 pts • 10 pts evaluated - Autocontours breast CTV - Autocontours breast PTV - Autocontours OARs - Autocontours pelvic lymph nodes CTV - Autocontours OARs Evaluation: Evaluation: - Dice Similarity Coefficient - Time savings - Dice Similarity Coefficient - Time savings Results Breast Cancer Anorectal Cancer Mean Dice Coefficient: Mean Dice Coefficient: CTV = 0.85 PTV = 0.80 OARs = 0.75 CTV
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Dice corso_27.02
- 1. XXIII Corso Residenzialedi Aggiornamento Moderna Radioterapia e Diagnostica per Immagini: dalla definizione dei volumi alla radioterapia «adaptive» DICE il glossario per il corso M.A. Gambacorta, L. Boldrini, S. Longo, C. Valentini, D. Piccari
- 2.
- 3. Linee guida Modalità di trattamentopiù sofisticate Riduzione degli errori legati alla pianificazione
- 4. Linee guida Modalità di trattamentopiù sofisticate Riduzione degli errori legati alla pianificazione Adeguata conoscenza dei volumi da irradiare e una loro precisa delimitazione
- 5. Linee guida Modalità di trattamentopiù sofisticate Riduzione degli errori legati alla pianificazione Adeguata conoscenza dei volumi da irradiare e una loro precisa delimitazione LINEE GUIDA
- 6. Gregoire et alRadiotherapy and Oncology 69 (2003) 227–236
- 7. Linee guida Vantaggi • definizionedi un linguaggio multispecialistico • standardizzazione delle modalità di contornazione intraspecialistico
- 8. Anal cancer Eendometrial andcervical cancer Internal iliac lymph nodes Cranial: Bifurcation of the common iliac artery into the external and internal iliac arteries Caudal: where the fibers of the levator ani insert into the obturator fascia and obturator internus, and can be demarcated either at the level of the obturator canal, or at the level where there is no space between the obturator internus muscle and the midline. Lateral: The medial edge of the obturator internus in the lower pelvis; iliopsoas muscle in the upper pelvis. Medial: The mesorectum and the presacral space in the lower pelvis . Anterior: The obturator internus muscle or bone in the lower pelvis. In the upper pelvis, a 7-mm margin around the internal iliac vessels Michael et al IJROBP 2011 Internal iliac lymph nodes VS From level of bifurcation of common iliac artery into internal artery, along its branches (obturator, hypogastric) terminating in paravaginal tissues at level of vaginal cuff Small et al IJROBP 2008
- 9. Anal cancer Eendometrial and cervicalcancer Internal iliac lymph nodes Cranial: Bifurcation of the common iliac artery into the external and internal iliac arteries Caudal: where the fibers of the levator ani insert into the obturator fascia and obturator internus, and can be demarcated either at the level of the obturator canal, or at the level where there is no space between the obturator internus muscle and the midline. Lateral: The medial edge of the obturator internus in the lower pelvis; iliopsoas muscle in the upper pelvis. Medial: The mesorectum and the presacral space in the lower pelvis . Anterior: The obturator internus muscle or bone in the lower pelvis. In the upper pelvis, a 7-mm margin around the internal iliac vessels Internal iliac lymph nodes VS From level of bifurcation of common iliac artery into internal artery, along its branches (obturator, hypogastric) terminating in paravaginal tissues at level of vaginal cuff
- 10. Linee guida: differenze Inview of the differences observed between the Brussels and the Rotterdam guidelines A multidisciplinary working group, including members from both the original Brussels and Rotterdam groups, was created to try to create a unified set of recommendations for the delineation of the various levels in the clinically uninvolved, ‘node-negative’ neck. Gregoire et al Radiotherapy and Oncology 69 (2003) 227–236
- 11. Linee guida: differenze 1.The mesorectal lymph nodes (MLN), 2. the lateral lymph nodes (LLN): internal iliac lymph nodes, 3. the external iliac lymph nodes (ELN), and the inguinal lymph nodes (ILN). Roels et al Int. J. Radiation Oncology Biol. Phys., Vol. 65, No. 4, pp. 1129–1142, 2006
- 12. Linee guida: differenze Myersonet al Int J Radiat Oncol Biol Phys. 2009 July 1; 74(3): 824–830
- 13. Linee guida: differenze SUP:Bifurcation of IMA (Peritoneal fold /rectosigmoid junction) ANT: Denonvillers fascia SUP :Rectosigmoid junction ANT: small intestin Mesorectum: upper limit Roels et al Int. J. Radiation Oncology Biol. Phys., Vol. 65, No. 4, pp. 1129–1142, 2006 Myerson et al Int J Radiat Oncol Biol Phys. 2009 July 1; 74(3): 824–830
- 14. Linee guida: differenze ANT:Denonvillers fascia ANT: 1 cm into the posterior bladder Mesorectum: anterior limit Roels et al Int. J. Radiation Oncology Biol. Phys., Vol. 65, No. 4, pp. 1129–1142, 2006 Myerson et al Int J Radiat Oncol Biol Phys. 2009 July 1; 74(3): 824–830
- 15. Linee guida edifferenze interoperatore Observers (n=14) Contour Scan 1 Rectal cancer pt cT3 cN0 Group A=Experimental group (n=7) Group B=Control group (n=6) Randomization Atlas No Atlas Contour Scan 2 Contour Scan 2 Fuller et al, Int J Radiat Oncol Biol Phys. 2011 February 1; 79(2): 481–489
- 16. Linee guida edifferenze interoperatore Group A (Contour Scan 1: WITHOUT ATLAS) Group A (Contour Scan 2: WITH ATLAS) p-value 0.68 0.76 0.03 0.58 0.69 0.02 CN coefficient CTVA (Internal Iliac, presacral, perirectal nodes) CN coefficient CTVA with expert reference (Internal Iliac, presacral, perirectal nodes) Fuller et al, Int J Radiat Oncol Biol Phys. 2011 February 1; 79(2): 481–489
- 17. Gli indici disimilarità
- 18. Gli indici disimilarità Chao K.S.C. et al. – Int J Radiat Oncol Biol Phys – 2
- 19. Gli indici disimilarità 1. Soggettivi 2. Planari 3. Volumetr ici Volumetrici
- 20. Gli indici disimilarità planari - Jaccard - Hausdorff - Dice
- 21. Gli indici disimilarità planari Indice di Jaccar d IA ∩ BI IA ⋃ BI No overlap = 0 Overlap totale = 1
- 22. L’indice di Jaccard - ValeSOLO per 2 contornazioni Molto sensibile a situazioni estreme Poco usato in letteratura Per confrontare > 2 volumi : V comune contornato IJ common : V totale contornato IJ pairs : media aritmetica IJ tutte possibili coppie
- 23. Gli indici disimilarità planari Distanza di Hausdorff
- 24. La distanza diHausdor ff d(X ,Y) = max {sup inf d(x,y), sup inf d(x,y)} y∊Y x∊X y∊Y x∊X Calcola la distanza tra due sottoinsiemi di punti in uno spazio metr ico
- 25. L’indice di Dice “Inmany ecologic studies there is need to express in a quantitative manner the degree to which two different species are associated in nature. Nevertheless, no such measure has up to the present time come into generale use by ecologists.” Dice L.R. – Ecology – (1945) 26; 3; 297
- 26. Gli indici disimilarità planari Indice di Dice 2 IA ∩ BI IA I + IBI No overlap = 0 Overlap totale = 1
- 27. L’indice di Dice -IA I + IBI sempre > IA ⋃ BI - Intr oduzione del fattor e di nor malizzazione 2 - Meno sensibile a situazioni estr eme - Cr escita più lineare dell’ IJ - Molto utilizzato in letteratura
- 28. L’indice di Dice Principali applicazioni cliniche • • • • • Valutazione Valutazione Valutazione Valutazione Valutazione contornazioni Replanning contornazioni A utocontour ing variabilità inter-intraoper ator e variabilità anatomica curva di appr endimento
- 29. Gli indici disimilarità volumetrici - Semplici Valutazione spostamento baricentro Differenza assoluta cc - Complessi Indice di Minkowski
- 30. L’indice di Minkowski MIሺ Bሺ = A, 2 Vሺ ሺ B 3 1 (A)3 ∙V Vm (AB) Misura la similarità di forma tra 2 volumi Se A = B Difficoltà : MI = 1 Equazione oper ativa Vm
- 31. Gli indici disimilarità: who is who? 1. Medico Valida CTV, Lfn e OaR se necessa Valida softwar e 2. FisicoCura aspetti matematici Valida softwar e 3. TSRM Utilizza softwar e per calcolo IS Propone contor nazioni al medico
- 32. Utilizzo clinico delsistema MIM
- 33. - Replanning recontour ing H&N - A cquisizione e definizione di volumi da imaging funzionale PET
- 34. Replanning recontouring H&N Obiettivi -Mantenere l’integr ità del piano iniziale - A ssicurar e coper tur a CTV - Preservare OaR - Ottimizzare dosimetr ia su nuova anatomia: - r egr essione CTV - per dita di peso
- 35. Replanning recontour ingH&N Quando? 5°- 6° settimana / 36 Gy (7020 cGy)
- 36. Replanning recontour ingH&N Come? A utocontouring Software di coregistrazione deformabile
- 37.
- 38. MIM Replanning recontouring H&N
- 39. MIM Replanning recontouring H&N
- 40. MIM Replanning recontouring H&N VoxA lign Deformation Engine
- 41. MIM Replanning recontouring H&N
- 42. MIM Replanning recontouring H&N
- 43. Valutazione del risultato Valutazionedel risultato Calcolo coefficiente di Dice tra - Str ucture Set ottenuto dalla contor nazione MIM Replanning recontouring - Str ucture Set contornato manualmente ex novo sulla TC di Replanning
- 44. Valutazione del risultato : gli OaR Or gano a r ischio Coefficiente di Dice Encefalo 0.97 Tr onco dell’encefalo 0.82 Canale midollar e 0.75 Occhio dx 0.80 Occhio sn 0.86 Cavo or ale 0.83 Par otide dx 0.80 Par otide sn 0.79
- 45. Valutazione del risultato : gli OaR Or gano a r ischio Coefficiente di Dice Mandibola 0.77 Lar inge 0.89 Clavicola dx 0.77 Clavicola sn 0.86 Testa omer o dx 0.89 Testa omer o sn 0.91 Coefficiente di Dice medio OaR = 0.83 (0.750.97)
- 46. PROSPETTIVE FUTURE - Imagefusion : RM (pelvi), PET, imaging 4D, CBCT - Contour ing : A utocontouring da atlante anatomico Replanning in altri distr etti
- 47.
- 48.
- 50. Material & Methods CTV=pelvic Lymphnodes ATLAS creation (15 pts) 10 test pts Contoured by 3 RO (time recorded) Anatomical characteristics autosegmentation Autosegmentation Correction 1 week later (time recorded) Evaluation of Dice Similarity Coefficient and time savings for target delineation between RO and autosegmented pts
- 51. Results Mean Dice Coefficient=0.8 Spared Time=26% ManualContour Auto+Correction
- 52. ABAS: enables the autosegmentation withthe use of just one pt STAPLE algorithm: enables the user to choose an arbitrary number of atlases to serve as template for one pt case. The algorithm then creates and presents a results which is the represents a combined segmentation based on averaging the individual contours.
- 53. Material & Methods BreastCancer pts Anorectal cancer pts • Creation of 3 ATLAS based on breast volume (small medium and large) • 9 pts evaluated for each ATLAS • Contouring of the whole breast (including chest wall) • Manual vs ABAS • Manual vs STAPLE algorithm • No time recorded • DSC evaluation • Brest cancer Mean Dice Coefficient=0.860.91 Anorectal cancer Mean Dice Coefficient=0.790.85 • • • • • • Creation of 4 ATLAS (2 for female and 2 for male: 1 high and 1 deep pt for each gender) 5 pt evaluated for all groups and gender RTOG guidelines (CTVA, CTVB and CTVC) Manual vs ABAS Manual vs STAPLE algorithm No time recorded DSC evaluation
- 55. ABAS: enables the autosegmentatio n withthe use of just one pt STAPLE algorithm: enables the user to choose an arbitrary number of atlases to serve as template for one pt case. The algorithm then creates and presents a results which is the represents a combined segmentation based on averaging the individual contours.
- 56. Material & Methods CTV=H&N lymphnodes (level I-V) 20 OAR Contoured by 10 RO (time recorded) Correction by expert panel ATLAS creation (10 pts, 4 stage N0, 6 stage N+) 12 test pts for each stage (N0N+ Anatomical characteristics autosegmentation Autosegmentation (time recorded) Correction by expert panel (time recorded) Evaluation of Dice Similarity Coefficient and Time Savings for target delineation between RO and autosegmented pts
- 57. Results Mean Dice CoefficientCTV=0.67 Mean Dice Coefficient OaR=0.50-0.79 Time efficiency=56%
- 58. N°of pts Young et 10 al Evaluated districts Anatomical charactaristics considered Pelvic nodal volumesin endometrial cancer adj therapy Anteroposterior and lateral separation. BMI not available for all pts Adjuvant group) Brest cancer 9 (per Anders et al 6 Teguh et 5 al Anorectal cancer H&N nodal level and OAR Breast size Gender and location of tumor Mean Dice coefficien t Spared time 26% 0.8 (p<0.00000 1) 0.86-0.91 - 0.79-0.85 - 0.67-0.79 56%
- 59. Primary and point:to investigate dosimetric implications of not editing auto-contoured neck levels and OARs derived with ABAS for head and neck cancer patients. Secondary and point:to investigate whether observed favourable Dice Coefficient or mean contour distances (between adited and not-edited strctures) sets do indeed predict fo low PTV underdosage.
- 60. Material & Methods 10H&N pts ABAS autocontouring ABAS PTV OBS1 PTV IMRT plans OBS2 PTV
- 61. Material & Methods Whichparametres investigated? V95(percentage of volume V95 receiving more than 95%of the prescribed dose) and D99 (minimum dose delivered to 99% of PTVobs1 and PTVobs2)
- 62.
- 63.
- 65. UCSC SS-Validation Program Aimofthe study P roof of Concept
- 66. UCSC SS-Validation Program Aimofthe study To test CTV autosegmentation system for locally advanced rectal cancer in term of • Reliability • Time for the final delineation (only in clinical setting) • Segmentation modalities
- 67. UCSC SS-Validation Program ClinicalSetting: Study design Manual Segmentation (MS) + IC vs Auto Segmentation (AS) + IC
- 68. UCSC SS-Validation Program EducationalSetting: S tudy design Autosegmentation + Manual Revision + IC vs Manual + Autosegmentation + Manual Revision + IC
- 69. UCSC SS-Validation Program S tudydesign • 14 CT scan of 14 rectal cancer pts: – 4 ATLAS – 10 TEST group • STRUCTURE SET: – contoured according to International guide line lin
- 70. UCSC SS-Validation Program CTVdefinition Target volume modulation according to stage and location Presaral space Mesorectum Internal iliac nodes cT3 high (above the peritoneal reflection) cT3 mid-low (at the peritoneal reflection) + + + + + + Any cT with massive positive internal iliac nodes + Any cT with massive positive obturator nodes nodes + cT4 with for anterior pelvic organ + + + + + + + (when direct tumor infiltration) + + (when direct tumor infiltration) + + (when APR required) + + (when direct tumor infiltration) + + + (when APR required) + + + ischiorectal fossa (when APR required) + Extrenal iliac nodes sphincter complex (when APR required) + Obturator nodes (when direct tumor infiltration) Arcangeli S, Rays. 2003 Jul-Sep;28(3):331-6 Roels S, Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1129-42.
- 71. UCSC SS-Validation Program P roofof Concept Results
- 72. UCSC SS-Validation Program ClinicalSetting: CTV dice com parison * p = 0,0195 SM MS DICE 0.75 SA AS 0.70
- 73. UCSC SS-Validation Program Overallstructures dice com parison * p= 0.0195 SM MS SA AS DICE 0.68 0.59
- 74. Internal Iliac Subsite ManualSegmentation Master contour Automatic Segmentation Autosegmentation contour Manual contour Master contour Master contour Manual contour Autosegmentation contour Median Dice coefficient= 0,645 Median Dice coefficient= 0,590 Master contour
- 75. Onturator Subsite Manual Segmentation Manualcontour Master contour Manual contour Master contour Median Dice coefficient= 0,550 Automatic Segmentation Automatic contour Automatic contour Master contour Master contour Median Dice coefficient= 0,525
- 76. Total Time comparison Clinicalsetting CTV N Overall structures Median overall time MS 10 16’ 38’ AS 10 12’ 25’ SA+M 10 27.6 73.1 Spared TIME: SM+A 10 25% 15.5 34% 35.2
- 77. UCSC SS-Validation Program Overallstructures total tim com e parison p = 0.002 MS TT 38 min AS TT 25 min Median Spared TIME: 13/38 min (34%)
- 78. Dice Summary CTV& sub volumes CTV Ext Iliac Int Iliac Obturator Mesorect um Presacral Median N Manual 10 + IC 0,755 0,670 0,645 0,550 0,730 0,395 Automat 10 ic + IC 0,700 0,445 0,590 0,525 0,695 0,395 AutoManual 10 + IC 0,750 0,680 0,695 0,620 0,740 0,405 Manualauto 10 +IC 0,750 0,650 0,675 0,580 0,755 0,395
- 79. UCSC SS-Validation Program Conclusion P roofof Concept • AutoSegmentation + IC – Concern for sub-volumes (volume cm3, anatomical landmarks) – Spares time (spared time 25-34%) – Worty further investigation – Never avoid Independent Check
- 80. N°of pts Evaluated districts Anatomical charactaristics considered 10 Pelvic nodal volumes in endometrial canceradj therapy Anteroposterior and lateral separation. BMI not available for all pts 9 (per Adjuvant Brest cancer Breast size 6 Anorectal cancer Gender and location of tumor 5 H&N nodal level and OAR Young et al, Int. J. Radiation Oncology Biol. Phys., Vol. 79, No. 3, pp. 943–947, 2011 Anders et al, Radiotherapy and Oncology 102 (2012) 68–73 group) Teguh et al, Int. J. Radiation Oncology Biol. Phys., Vol. 81, No. 4, pp. 950–957, 2011 Gambacorta et al, 10 Acta Oncol. 2013 Jan 22. [Epub ahead of print] Pelvic lymph nodes in locally advanced rectal cancer Mean Dice coefficient 0.8 Spared time 26% (p<0.000001) - 0.79-0.85 - 0.67-0.79 Sex, age, weight, height, BMI, menopausal state, sacro-cocciegeal distance, most anterior distance between upper iliac crests 0.86-0.91 56% 0.70 25-34%
- 81. UCSC SS-Validation Program ClinicalSetting Perspective Study
- 82. UCSC SS-Validation Program ClinicalSetting: S tudy design • 44 CT scan of 44rectal cancer pts: – 14 ATLAS – 30 TEST group (Consecutive patients) • STRUCTURE SET: – contoured according to International guide line lin Arcangeli S, Rays. 2003 Jul-Sep;28(3):331-6 Roels S, Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1129-42.
- 83. UCSC SS-Validation Program RectalCancer Subsites • Subsites: Subvolume1: Mesorectum+Presacral space Subvolume 2a: Internal Iliac + Obturator Nodes Subvolume 2b: External Iliac Nodes • CTV: – CTV_T3_mid ; CTV_T3_low, CTV_T4 • OAR: B: Bladder; FH: Femural Head Arcangeli S, Rays. 2003 Jul-Sep;28(3):331-6 Roels S, Int J Radiat Oncol Biol Phys. 2006 Jul 15;65(4):1129-42.
- 84. UCSC SS-Validation Program ClinicalSetting: Assignem ent • Operator 1 (junior) : TEST group 10 pts • Segmentation (atlas based) A. Manual Segmentation (MS) B. Autosegmentation (AS) • Time for each delineation modality • Anonimized patients and segmentation modalities • Random segmentation In each working-session different patient and
- 85. UCSC SS-Validation Program ClinicalSetting: Assignem ent Operator 2 (senior): • Manual delineation (atlas based) – Test 30 pts ( Manual Reference Segmentation; MRS) – never visible to operator 1 • Independent Check of all segmentation modalities of all structures ; • Time
- 86. UCSC SS-Validation Program • • • • • • • • LibraryOntology Sex Age Weight Height BMI Menopausal state Sacrum coccigeal distance Most anterior distance between upp iliac crests
- 87. UCSC SS-Validation Program ClinicalSetting: Perspective Study Results
- 88. UCSC SS-Validation Program CTVDice Manual vs Auto p<0.0001 Mean DICE 0.84 0.75
- 89. UCSC SS-Validation Program CTVTT manual vs auto p<0.0001 Median spared time 10.47min Mean TT 0.84 23,75 0.75 13,28
- 90. Uncertainties • Choice ofATLAS patients (number of pts) • Anatomical characteristics for segmentation • Never avoid Indipendent Check
- 91. Conclusion QA programs recommendIndependent Check (I.C.) for delicate steps in RT planning/treatment. IC not commonly done in delineation W orkflow for contouring in our Centre Operator 1 Delineation final delineation Atlas based guidelines Operator 2 IC Treatment plan
Editor's Notes
- #48 In accordance with improved technology
- #50 End point
- #78 Questo mi serve per clinical practice!! Per training voglio sapere differenza di tempo tra SM vs S M+A e SM vs S A+M. GIUSTO? Se queste sono statisticamente significative e a favore di chi. Ossia stesso grafico e dati di questa slide! (quindi 2 grafici)