title: Semi-automatic delineation using weighted CT-MRI registered images for radiotherapy of nasopharyngeal cancer.
abstract: OBJECTIVE
  To develop a delineation tool that refines physician-drawn contours of the gross tumor volume (GTV) in nasopharynx cancer, using combined pixel value information from x-ray computed tomography (CT) and magnetic resonance imaging (MRI) during delineation.
  
  
  METHODS
  Operator-guided delineation assisted by a so-called "snake" algorithm was applied on weighted CT-MRI registered images. The physician delineates a rough tumor contour that is continuously adjusted by the snake algorithm using the underlying image characteristics. The algorithm was evaluated on five nasopharyngeal cancer patients. Different linear weightings CT and MRI were tested as input for the snake algorithm and compared according to contrast and tumor to noise ratio (TNR). The semi-automatic delineation was compared with manual contouring by seven experienced radiation oncologists.
  
  
  RESULTS
  A good compromise for TNR and contrast was obtained by weighing CT twice as strong as MRI. The new algorithm did not notably reduce interobserver variability, it did however, reduce the average delineation time by 6 min per case.
  
  
  CONCLUSIONS
  The authors developed a user-driven tool for delineation and correction based a snake algorithm and registered weighted CT image and MRI. The algorithm adds morphological information from CT during the delineation on MRI and accelerates the delineation task.
authors.affiliation: European Georges Pompidou Hospital, Department of Radiology, 20 rue Leblanc, 75015 Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Fitton
authors.forename: S A P
authors.initials: SA
authors.lastname: Cornelissen
authors.forename: J C
authors.initials: JC
authors.lastname: Duppen
authors.forename: R J H M
authors.initials: RJ
authors.lastname: Steenbakkers
authors.forename: S T H
authors.initials: ST
authors.lastname: Peeters
authors.forename: F J P
authors.initials: FJ
authors.lastname: Hoebers
authors.forename: J H A M
authors.initials: JH
authors.lastname: Kaanders
authors.forename: P J C M
authors.initials: PJ
authors.lastname: Nowak
authors.forename: C R N
authors.initials: CR
authors.lastname: Rasch
authors.forename: M
authors.initials: M
authors.lastname: van Herk
mesh_terms: D000368:Aged; D000465:Algorithms; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data; D012984:Software; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data