title: Visualisation of the left anterior descending coronary artery on CT images used for breast radiotherapy planning.
abstract: OBJECTIVE
  To assess the visualisation of the left anterior descending (LAD) coronary artery on CT images used for breast radiation treatment planning.
  
  
  METHODS
  Delineation of the LAD artery was achieved for 25 breast patients by 1 radiologist and 1 radiation oncologist independently on two sets of images for each patient: one pre-operative CT scan using intravenous (IV) contrast media to determine the primary gross tumour volume (GTV) and one post-operative CT scan used for treatment planning. A Student's paired t-test was used to compare the number of CT slices in which the LAD was visible for each patient in the two series. Interpolations and extrapolations of the LAD volume were performed for the left-sided cases using a published heart atlas in order to report doses to the LAD structure.
  
  
  RESULTS
  There was a non-significant difference between the results with and without IV contrast media (p=0.34 for the radiologist; p=0.90 for the radiation oncologist). The visible LAD artery corresponded to a 30% portion (range 12-47%) of the interpolated structure. The maximum dose to the left artery varied widely, from 2.7 to 41.7 Gy, in the group of patients with left breast tumours. The largest values (>25 Gy) corresponded to those patients in whom the LAD artery distal extremity lay inside the breast fields.
  
  
  CONCLUSIONS
  With the current planning CT protocol, only one-third of the LAD artery could be objectively visualised. Contrast-enhanced imaging used for GTV delineation before the breast surgery did not improve the visualisation of the artery.
  
  
  CONCLUSIONS
  This study has revealed the lack of consistency that may be encountered when contouring heart vessels, thereby questioning the reliability of dose reporting.
authors: Department of Radiation Oncology, Institut Curie, Paris, France.
authors: S
authors: S
authors: Vennarini
authors: N
authors: N
authors: Fournier-Bidoz
authors: C
authors: C
authors: Aristei
authors: C E
authors: CE
authors: de Almeida
authors: V
authors: V
authors: Servois
authors: F
authors: F
authors: Campana
authors: V
authors: V
authors: Mosseri
authors: A
authors: A
authors: Fourquet
authors: Y M
authors: YM
authors: Kirova
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden
chemical_list: D003287:Contrast Media