Multiple training interventions significantly improve reproducibility of PET/CT-based lung cancer radiotherapy target volume delineation using an IAEA study protocol.
To assess the impact of a standardized delineation protocol and training interventions on PET/CT-based target volume delineation (TVD) in NSCLC in a multicenter setting.



Over a one-year period, 11 pairs, comprised each of a radiation oncologist and nuclear medicine physician with limited experience in PET/CT-based TVD for NSCLC from nine different countries took part in a training program through an International Atomic Energy Agency (IAEA) study (NCT02247713). Teams delineated gross tumor volume of the primary tumor, during and after training interventions, according to a provided delineation protocol. In-house developed software recorded the performed delineations, to allow visual inspection of strategies and to assess delineation accuracy.



Following the first training, overall concordance indices for 3 repetitive cases increased from 0.57±0.07 to 0.66±0.07. The overall mean surface distance between observer and expert contours decreased from -0.40±0.03cm to -0.01±0.33cm. After further training overall concordance indices for another 3 repetitive cases further increased from 0.64±0.06 to 0.80±0.05 (p=0.01). Mean surface distances decreased from -0.34±0.16cm to -0.05±0.20cm (p=0.01).



Multiple training interventions improve PET/CT-based TVD delineation accuracy in NSCLC and reduce interobserver variation.
Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Tom
T
Konert
Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Wouter V
WV
Vogel
Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia.
Sarah
S
Everitt
Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia.
Michael P
MP
MacManus
Department of Radiation Oncology, University Hospital Tübingen, Germany.
Daniela
D
Thorwarth
Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria.
Elena
E
Fidarova
Department of Nuclear Sciences and Application, International Atomic Energy Agency, Vienna, Austria.
Diana
D
Paez
Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Jan-Jakob
JJ
Sonke
Centre for Cancer Research and Cell Biology, Queen's University of Belfast, United Kingdom. Electronic address: g.hanna@qub.ac.uk.
Gerard G
GG
Hanna
D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007390:International Agencies; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D009678:Nuclear Energy; D009683:Nuclear Medicine / Q000193:education*; D015588:Observer Variation; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D000072378:Radiation Oncologists / Q000193:education*; D015203:Reproducibility of Results; D012107:Research Design; D047368:Tumor Burden
Lung cancer; PET/CT; Radiation treatment planning; Radiotherapy; Target volume delineation; Training interventions