Recommendations on how to establish evidence from auto-segmentation software in radiotherapy

Along with the improved treatment conformity achieved with the recently implemented radiotherapy (RT) planning and delivery approaches [[1]Rodrigues G. Alexander L. Gregory V. et al.Categorizing segmentation quality using a quantitative quality assurance algorithm.J Med Imaging Radiat Oncol. 2012; 56: 668-678Crossref PubMed Scopus (5) Google Scholar], there is growing awareness of the uncertainties connected to the definition and delineation of the RT targets as well as the organs at risk (ORs). To assure accurate reproducibility of the planned treatment in order to avoid ‘geographical miss’ of the target, it is mandatory to correctly identify the volumes to be irradiated and to appropriately manage these uncertainties in the definition of the gross target volume (GTV) as well as of standardized, disease-specific, nodal clinical target volumes (CTVs).Accurate segmentation of primarily the GTVs and CTVs, as well as the ORs, therefore represents the foundation for successful RT. International or institutional guidelines, contouring atlases, case libraries and numerous recommendations have thus recently been developed [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of target volumes and in the and J Radiat Oncol Biol Phys. 2011; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google Scholar, L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, K. et quantitative and clinical of of target and in the and and J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, F. et of for segmentation for in and Oncol. 2012; PubMed Scopus Google Scholar, et with and Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, V. K. et of the for and a Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, J. et volume delineation in radiotherapy for cancer in the Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of delineation in using a and delineation Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google and and to have recently been for the atlases, to J. the of segmentation in clinical Med Radiat Scopus Google have for the segmentation the to the to the be a of in RT. to the of in RT L.C. of contouring with for cancer Oncol. Full Text Full Text PDF Scopus Google Scholar, L. et delineation of in radiotherapy for to Oncol. Full Text Full Text PDF Scopus Google Scholar, et of in and Oncol. Full Text Full Text PDF PubMed Scopus Google of the of is the of a and definition of the to the the as well as the of the be as V. and clinical of Scholar], and be to with the or and for the the and the of these in the to to and be the of the be in in and the be achieved with these to a of is and in a a of a and the the the is therefore the and in to the of contouring and the to segmentation of the of the of and segmentation J. A. et and for planning and 2012; PubMed Scopus Google segmentation is in with of the nodal the of the and for the of of the of as in the of cancer with or et radiotherapy and Oncol. PubMed Scopus Google Scholar], of nodal of for contouring and with the of the of the L. of the of nodal be in the nodal [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google definition and segmentation of the and clinical in for L. of the of for the and Oncol. PubMed Scopus Google RT there have been delineation there to represents the accurate and for of a of these the of the and as at with the of be a of A. K. et for target volume definition in radiotherapy for of the Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the clinical target volume J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the and Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, J. I. et volumes for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, I. et of for the definition of the clinical target volume for postoperative for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, J. A.V. of for contouring of and Oncol. Scholar, et contouring for a J Radiat Oncol Biol Phys. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, nodal a for the definition of clinical target volumes in PubMed Scopus Google with it is to the the the the of a delineation the or the of of a in contouring V. and clinical of Scholar, L. J. et et et segmentation using in and PubMed Scopus Google of is with to as well as a of approaches have been to the of the and and the of in or to V. and clinical of Scholar, of radiotherapy target volume a of Oncol Full Text Full Text PDF PubMed Scopus Google Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, of the of Google Scholar, et of to the of a contouring the is a is to is for a and is as a a of a and a as the is is the is to is with to the the a to the of a of the is is the have a clinical of of and clinical risk to a of at in a a a to the contouring definition is the of the contouring time to the time with the is to the time of the and to the time in the definition of the and in the case or a have in these in to the in segmentation time [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of target volumes and in the and J Radiat Oncol Biol Phys. 2011; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google Scholar, L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, K. et quantitative and clinical of of target and in the and and J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, F. et of for segmentation for in and Oncol. 2012; PubMed Scopus Google Scholar, V. and clinical of the of a segmentation of the represents the the be have well in to in the to in the L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google be to the L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, V. and clinical of Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, et in and of target volume delineation a using a J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google to a therefore be and to in as the of a of in clinical the of a the of the and be the to be be these a delineation or with the a the of or a of of the of these and a for the delineation is and the of the with a of represents a it a in the be a of recommendations be in of for of in be in delineation and the in the the target or and in the and the and a time for the of the a the the of the of the and the in the of of the and of the the contouring of using of a of the been a the of the contouring with the of of a the of a the the and a the of of the in the definition contouring and of a and the for delineation in a the of and to clinical the as well as definition of RT targets and clinical with to and the contouring of nodal is and be for is to the of in with of and et for the of of in and 2012; PubMed Scopus Google to in the and is to and approaches to and et in Oncol. PubMed Scopus Google Scholar, J. et for in a and to Oncol. a to in clinical and to volume and clinical is time the a and there in delineation of radiotherapy in the J Scopus Google Scholar, A. et of with in to in cancer Oncol. Full Text Full Text PDF Scopus (5) Google Scholar, et in delineation for and cancer in and Oncol. Full Text Full Text PDF PubMed Scopus Google the clinical of in a be a in case it be a be with of the the it is to the and to target et of to avoid risk of target Oncol. 2011; Full Text Full Text PDF PubMed Scopus Google recently in the have a the in to for and the volumes and the a in and target delineation uncertainties be L.C. of contouring with for cancer Oncol. Full Text Full Text PDF Scopus Google in et the of the of for in the L. et delineation of in radiotherapy for to Oncol. Full Text Full Text PDF Scopus Google is therefore to to the the and F. et volume delineation in with to postoperative Oncol. Full Text Full Text PDF PubMed Scopus Google be with to as the V. and clinical of the in of and a with the required in order to the clinical with to of the the of is the of the to contouring for in the and the of to using atlases, or to and of a and in the the to with and it the of the with for segmentation time and the to to be implemented and in clinical have a of recommendations with to the and to in the of clinical in of of for the and of the Along with the improved treatment conformity achieved with the recently implemented radiotherapy (RT) planning and delivery approaches [[1]Rodrigues G. Alexander L. Gregory V. et al.Categorizing segmentation quality using a quantitative quality assurance algorithm.J Med Imaging Radiat Oncol. 2012; 56: 668-678Crossref PubMed Scopus (5) Google Scholar], there is growing awareness of the uncertainties connected to the definition and delineation of the RT targets as well as the organs at risk (ORs). To assure accurate reproducibility of the planned treatment in order to avoid ‘geographical miss’ of the target, it is mandatory to correctly identify the volumes to be irradiated and to appropriately manage these uncertainties in the definition of the gross target volume (GTV) as well as of standardized, disease-specific, nodal clinical target volumes segmentation of primarily the GTVs and CTVs, as well as the ORs, therefore represents the foundation for successful RT. International or institutional guidelines, contouring atlases, case libraries and numerous recommendations have thus recently been developed [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of target volumes and in the and J Radiat Oncol Biol Phys. 2011; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google Scholar, L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, K. et quantitative and clinical of of target and in the and and J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, F. et of for segmentation for in and Oncol. 2012; PubMed Scopus Google Scholar, et with and Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, V. K. et of the for and a Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, J. et volume delineation in radiotherapy for cancer in the Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of delineation in using a and delineation Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google and and to To have recently been for the atlases, to J. the of segmentation in clinical Med Radiat Scopus Google have for the segmentation the to the to the be a of in RT. to the of in RT L.C. of contouring with for cancer Oncol. Full Text Full Text PDF Scopus Google Scholar, L. et delineation of in radiotherapy for to Oncol. Full Text Full Text PDF Scopus Google Scholar, et of in and Oncol. Full Text Full Text PDF PubMed Scopus Google of the of is the of a and definition of the to the the as well as the of the be as V. and clinical of Scholar], and be to with the or and for the the and the of these in the to to and be the of the be in in and the be achieved with these to a of is and in a a of a and the the the is therefore the and in to the of contouring and the to segmentation of the of the of and segmentation J. A. et and for planning and 2012; PubMed Scopus Google segmentation is in with of the nodal the of the and for the of of the of as in the of cancer with or et radiotherapy and Oncol. PubMed Scopus Google Scholar], of nodal of for contouring and with the of the of the L. of the of nodal be in the nodal [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google definition and segmentation of the and clinical in for L. of the of for the and Oncol. PubMed Scopus Google RT there have been delineation there to represents the accurate and for of a of these the of the and as at with the of be a of A. K. et for target volume definition in radiotherapy for of the Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the clinical target volume J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the and Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, J. I. et volumes for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, I. et of for the definition of the clinical target volume for postoperative for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, J. A.V. of for contouring of and Oncol. Scholar, et contouring for a J Radiat Oncol Biol Phys. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, nodal a for the definition of clinical target volumes in PubMed Scopus Google with it is to the the the the of a delineation the or the of of a in contouring V. and clinical of Scholar, L. J. et et et segmentation using in and PubMed Scopus Google to a of is and in a a of a and the the the is therefore the and in to the of contouring and the to segmentation of the of the of and segmentation J. A. et and for planning and 2012; PubMed Scopus Google segmentation is in with of the nodal the of the and for the of of the of as in the of cancer with or et radiotherapy and Oncol. PubMed Scopus Google Scholar], of nodal of for contouring and with the of the of the L. of the of nodal be in the nodal [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google definition and segmentation of the and clinical in for L. of the of for the and Oncol. PubMed Scopus Google RT there have been delineation there to represents the accurate and for of a of these the of the and as at with the of be a of A. K. et for target volume definition in radiotherapy for of the Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the clinical target volume J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, et of the and Oncol. Full Text Full Text PDF PubMed Scopus Google Scholar, J. I. et volumes for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, I. et of for the definition of the clinical target volume for postoperative for J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, J. A.V. of for contouring of and Oncol. Scholar, et contouring for a J Radiat Oncol Biol Phys. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, nodal a for the definition of clinical target volumes in PubMed Scopus Google with it is to the the the the of a delineation the or the of of a in contouring V. and clinical of Scholar, L. J. et et et segmentation using in and PubMed Scopus Google of is with to as well as a of approaches have been to the of the and and the of in or to V. and clinical of Scholar, of radiotherapy target volume a of Oncol Full Text Full Text PDF PubMed Scopus Google Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, of the of Google Scholar, et of to the of a contouring the is a is to is for a and is as a a of a and a as the is is the is to is with to the the a to the of a of the is is the have a clinical of of and clinical risk to a of at in a a a to the contouring definition is the of the contouring time to the time with the is to the time of the and to the time in the definition of the and in the case or of is with to as well as a of approaches have been to the of the and and the of in or to V. and clinical of Scholar, of radiotherapy target volume a of Oncol Full Text Full Text PDF PubMed Scopus Google Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, of the of Google Scholar, et of to the of a contouring the is a is to is for a and is as a a of a and a as the is is the is to is with to the the a to the of a of the is is the have a clinical of of and clinical risk to a of at in a a a to the contouring definition is the of the contouring time to the time with the is to the time of the and to the time in the definition of the and in the case or a have in these in to the in segmentation time [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of target volumes and in the and J Radiat Oncol Biol Phys. 2011; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google Scholar, L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, K. et quantitative and clinical of of target and in the and and J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, F. et of for segmentation for in and Oncol. 2012; PubMed Scopus Google Scholar, V. and clinical of the of a segmentation of the represents the the be have well in to in the to in the L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google be to the L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, V. and clinical of Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, et in and of target volume delineation a using a J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google to a therefore be and to in as the of a of in clinical the of a the of the and be the to be be these a delineation or with the a the of or a of of the of these and a for the delineation is and the of the with a of represents a it a a have in these in to the in segmentation time [2Young A.V. Wortham A. Wernick I. Evans A. Ennis R.D. Atlas-based segmentation improves consistency and decreases time required for contouring postoperative endometrial cancer nodal volumes.Int J Radiat Oncol Biol Phys. 2011; 79: 943-947Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 3Anders L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of target volumes and in the and J Radiat Oncol Biol Phys. 2011; Full Text Full Text PDF PubMed Scopus Google Scholar, et of of volumes and in using Oncol. PubMed Scopus Google Scholar, L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, K. et quantitative and clinical of of target and in the and and J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google Scholar, F. et of for segmentation for in and Oncol. 2012; PubMed Scopus Google Scholar, V. and clinical of the of a segmentation of the represents the the be have well in to in the to in the L.C. Stieler F. Siebenlist K. Schäfer J. Lohr F. F. of for delineation of target volumes for radiotherapy of and Oncol. 2012; Full Text Full Text PDF PubMed Scopus Google be to the L. G. et delineation for in is the to be as Oncol. PubMed Scopus Google Scholar, V. and clinical of Scholar, I. of for in target definition for 2012; PubMed Scopus Google Scholar, et in and of target volume delineation a using a J Radiat Oncol Biol Phys. Full Text Full Text PDF PubMed Scopus Google to a therefore be and to in as the of a of in clinical the of a the of the and be the to be be these a delineation or with the a the of or a of of the of these and a for the delineation is and the of the with a of represents a it a in the be a of recommendations be in of for of in be in delineation and the in the the target or and in the and the and a time for the of the a the the of the of the and the in the of of the and of the the contouring of using of a of the been a the of the contouring with the of of a the of a the the and a the of of the in the definition contouring and of a and the for delineation in a the of and to clinical the as well as definition of RT targets and clinical with to and the contouring of nodal is and be for is to the of in with of and et for the of of in and 2012; PubMed Scopus Google to in the and is to and approaches to and et in Oncol. 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