Combined Ultrasound and Cone Beam CT Improves Target Segmentation for Image Guided Radiation Therapy in Uterine Cervix Cancer.
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Date
2019-07-01Author
Mason, SA
White, IM
O'Shea, T
McNair, HA
Alexander, S
Kalaitzaki, E
Bamber, JC
Harris, EJ
Lalondrelle, S
Type
Journal Article
Metadata
Show full item recordAbstract
PURPOSE: Adaptive radiation therapy strategies could account for interfractional uterine motion observed in patients with cervix cancer, but the current cone beam computed tomography (CBCT)-based treatment workflow is limited by poor soft-tissue contrast. The goal of the present study was to determine if ultrasound (US) could be used to improve visualization of the uterus, either as a single modality or in combination with CBCT. METHODS AND MATERIALS: Interobserver uterine contour agreement and confidence were compared on 40 corresponding CBCT, US, and CBCT-US-fused images from 11 patients with cervix cancer. Contour agreement was measured using the Dice similarity coefficient (DSC) and mean contour-to-contour distance (MCCD). Observers rated their contour confidence on a scale from 1 to 10. Pairwise Wilcoxon signed-rank tests were used to measure differences in contour agreement and confidence. RESULTS: CBCT-US fused images had significantly better contour agreement and confidence than either individual modality (P < .05), with median (interquartile range [IQR]) values of 0.84 (0.11), 1.26 (0.23) mm, and 7 (2) for the DSC, MCCD, and observer confidence ratings, respectively. Contour agreement was similar between US and CBCT, with median (IQR) DSCs of 0.81 (0.17) and 0.82 (0.14) and MCCDs of 1.75 (1.15) mm and 1.62 (0.74) mm. Observers were significantly more confident in their US-based contours than in their CBCT-based contours (P < .05), with median (IQR) confidence ratings of 7 (2.75) versus 5 (4). CONCLUSIONS: CBCT and US are complementary and improve uterine segmentation precision when combined. Observers could localize the uterus with a similar precision on independent US and CBCT images.
Collections
Subject
Cervix Uteri
Humans
Observer Variation
Ultrasonography
Radiotherapy Planning, Computer-Assisted
Statistics, Nonparametric
Self Concept
Reference Standards
Middle Aged
Uterine Cervical Neoplasms
Female
Urinary Bladder
Cone-Beam Computed Tomography
Radiotherapy, Image-Guided
Multimodal Imaging
Research team
Clinical Academic Radiotherapy (Dearnaley)
Gynaecological Cancer
Imaging for Radiotherapy Adaptation
Ultrasound & Optical Imaging
Language
eng
Date accepted
2019-03-03
License start date
2019-07
Citation
International journal of radiation oncology, biology, physics, 2019, 104 (3), pp. 685 - 693
Publisher
ELSEVIER SCIENCE INC