Multi-centre evaluation of variation in cumulative dose assessment in reirradiation scenarios

累积剂量 核医学 累积发病率 医学 一致性(知识库) 头颈部 医学物理学 计算机科学 外科 人工智能 移植
作者
Nicholas Hardcastle,E. Vásquez Osorio,Andrew Jackson,Charles W. Mayo,Anja Einebærholm Aarberg,M. Ayadi,Francesca Belosi,Cemile Ceylan,A. Davey,P. Dupuis,Joshua Handley,Theresa Hemminger,Lone Hoffmann,Colin Kelly,C. Michailidou,Sarah Muscat,Donna H. Murrell,J. Fernández,Catherine G. Palmer,L. Placidi,Marija Popović,H.S. Rønde,Allison Selby,T. Skopidou,Natasa Solomou,J. Stroom,Christopher Thompson,Nick West,Ali Zaila,Ane L. Appelt
出处
期刊:Radiotherapy and Oncology [Elsevier BV]
卷期号:194: 110184-110184
标识
DOI:10.1016/j.radonc.2024.110184
摘要

Safe reirradiation relies on assessment of cumulative doses to organs at risk (OARs) across multiple treatments. Different clinical pathways can result in inconsistent estimates. Here, we quantified the consistency of cumulative dose to OARs across multi-centre clinical pathways.We provided DICOM planning CT, structures and doses for two reirradiation cases: head & neck (HN) and lung. Participants followed their standard pathway to assess the cumulative physical and EQD2 doses (with provided α/β values), and submitted DVH metrics and a description of their pathways. Participants could also submit physical dose distributions from Course 1 mapped onto the CT of Course 2 using their best available tools. To assess isolated impact of image registrations, a single observer accumulated each submitted spatially mapped physical dose for every participating centre.Cumulative dose assessment was performed by 24 participants. Pathways included rigid (n = 15), or deformable (n = 5) image registration-based 3D dose summation, visual inspection of isodose line contours (n = 1), or summation of dose metrics extracted from each course (n = 3). Largest variations were observed in near-maximum cumulative doses (25.4 - 41.8 Gy for HN, 2.4 - 33.8 Gy for lung OARs), with lower variations in volume/dose metrics to large organs. A standardised process involving spatial mapping of the first course dose to the second course CT followed by summation improved consistency for most near-maximum dose metrics in both cases.Large variations highlight the uncertainty in reporting cumulative doses in reirradiation scenarios, with implications for outcome analysis and understanding of published doses. Using a standardised workflow potentially including spatially mapped doses improves consistency in determination of accumulated dose in reirradiation scenarios.
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