1

Group 1

July 16, 2017

Research Outline

Research Paper Outline Summary

I. ABSTRACT: This will be left blank until the end of the semester.

II. Introduction

A. A growth in technology has changed the spectrum of radiation oncology and has created
the ability to irradiate and target specific tumor volumes while sparing organs at risk
(OR) via contours drawn by medical professionals.
B. Contours create dose tracking to not only target volumes but also OR; however, incorrect
contours or variances within contours can create inaccurate dose administration and
tracking.
C. What causes contour variances?
1. Does level of education affect contouring ability?
2. What level of variance can lead to miscalculated dose levels?
D. Is there a need to study contouring variability?
E. The primary objective of this study is to investigate the degree of inter-clinician
variability in contouring OR and target volumes and to determine theassociated effects it
has on the outcome of the treatment plan..

III. Methods and Materials

A. Patients

1. The criteria for the selection of the patient CT was that the patient presented with
a history of intermediate risk prostate cancer.
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2. The patient was scanned utilizing a Philips wide bore CT simulator in a head first
supine (HFS) position and then proceeded to have an MRI taken with a Philips 3T
Ingenia, where a balance turbo field-echo (BTFE) sequenced scan was performed.

B. Contouring

1. The digital imaging and communications in medicine DICOM fused CT/MRI Commented [P1]: Spell out 1st then abbreviate.

dataset was imported into each individual users contouring application at their
clinical facility.
2. The medical professional (medical dosimetrist or radiation oncologist) contoured
five organs including the bladder, penile bulb, prostate, rectum, and seminal
vesicles.

i. A gross-tumor volume (GTV), clinical target volume (CTV), and planning

target volume (PTV) were created in a standardized manner by the
medical professional, as specified in the RTOG 0126 protocol. Commented [P2]: Spell out initially.

ii. The GTV included the prostate only, the CTV encompassed the prostate in
addition to the bilateral seminal vesicles, and the PTV consisted of the
CTV with a 5mm margin.

3. A gold standard dataset was contoured by a physician provided by ProKnow and

served as a key comparison to grading and deciphering differences in the contours
and planning volumes.
C. Treatment Planning
1. One acceptable treatment plan was generated and used as a constant for each
Commented [Py3]: Instructor: The last paragraph should
contain a sentence such as The aim of this study was to.
You may go into these details in this paragraph as long as it
directly relates to the subject of your research. Avoid going
into too much detail about how you will conduct your
research as this should be included in the materials and
methods sections.

structure dataset uploaded, adhering to the prescription of 39 fractions at 180 cGy

per fraction for a cumulative dose of 7020 cGy.

i. Specific RTOG 0126 guidelines were followed to meet dose constraints

for target volumes and OR.
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2. A DVH (dose-volume histogram) was plotted for every single submitted structure Commented [P4]: Spell out 1st, then use the abbreviation.

dataset incorporated into the base treatment plan demonstrating OR and target
volumes for contouring variation evaluation.
D. Plan Comparisons
1. The base treatment plan comprising each unique set of contours was scored
against the pertinent metrics applying the PlanIQ Method, with each metric
having a customized numeric score function.

IV. Results

A. Inter-clinician variation per OR was quantified by several methods, all using a

commercially available structure set analysis software program called StructSure
supplied by ProKnow.
B. The difference in the mean and maximum dose for each individual OR was analyzed.
C. Following the trends in variability of contouring, the rectum and bladder demonstrated
the most consistent and the OR that were shown to be most variable were the penile bulb
and seminal vesicles.

V. Discussion

A. OR Variability Metrics
1. Questioning the gold standard as the specified standard can vary between clinical
facilities and physicians.
B. OR Variability Impact
1. The location and proximity of the OR to a dose region receiving a significant dose
can impact the course of treatment to the patient depending on if the contour is
under-drawn or over-drawn.
C. Need for a Quality System of Anatomy Contouring
1. Additional supplemental training could be implemented within the department to
improve the accuracy and consistency of anatomical contouring.
2. The goal was to increase contouring accuracy and decrease variation in order to
produce a cost effective method to improve the quality of care to the patient.

VI. Conclusion
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References:

1. Nelms BE, Tom WA, Robinson G, Wheeler J. Variations in the contouring of organs at
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http://dx.doi.org/10.1016/j.meddos.2016.08.004
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717X-8-176
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http://dx.doi.org/10.1016/j.ijrobp.2011.02.050
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10. Li XA, Tai A, Arthur DW, et al. Variability of target and normal structure delineation for
breast cancer radiotherapy: an RTOG multi-institutional and multiobserver study. Int J
Radiat Oncol Biol Phys. 2009;73(3):944-951. http://dx.doi:10.1016/j.ijrobp.2008.10.034
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complication probability. Radiother Oncol. 2002;63(3):249-255.
http://dx.doi.org/10.1016/S0167-8140(01)00469-8