title: Internal and external validation of an ESTRO delineation guideline - dependent automated segmentation tool for loco-regional radiation therapy of early breast cancer.
abstract: To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer.
  
  
  
  Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized multi-atlas libraries using MIM Maestro™ software. These libraries were used for auto-segmentation in two different patient groups (50 patients from the local institution and 40 patients from other institutions). Dice Similarity Coefficient, Average Hausdorff Distance, difference in volume and time were computed to compare ABAS before and after correction against a gold standard manual segmentation (MS).
  
  
  
  ABAS reduced the time of MS before and after correction by 93% and 32%, respectively. ABAS showed high agreement for lung, heart, breast and humeral head, moderate agreement for chest wall and axillary nodal levels and poor agreement for interpectoral, internal mammary nodal regions and LADCA. Correcting ABAS significantly improved all the results. External validation of ABAS showed comparable results.
  
  
  
  ABAS is a clinically useful tool for segmenting structures in breast cancer loco-regional radiation therapy in a multi-institutional setting. However, manual correction of some structures is important before clinical use. The ABAS is now available for routine clinical use in Danish patients.
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Oncology and Nuclear Medicine, Mansoura University, Egypt.
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Eldesoky
authors.affiliation: Department of Medical Physics, Aarhus University Hospital, Denmark.
authors.forename: Esben S
authors.initials: ES
authors.lastname: Yates
authors.affiliation: Department of Medical Physics, Aarhus University Hospital, Denmark.
authors.forename: Tine B
authors.initials: TB
authors.lastname: Nyeng
authors.affiliation: Department of Medical Physics, Aarhus University Hospital, Denmark.
authors.forename: Mette S
authors.initials: MS
authors.lastname: Thomsen
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Hanne M
authors.initials: HM
authors.lastname: Nielsen
authors.affiliation: Department of Radiation Oncology, Radboud University Medical Center, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Poortmans
authors.affiliation: Department of Radiation Oncology, Catholic University of Louvain, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: Kirkove
authors.affiliation: German Cancer Consortium (DKTK) Dresden and German Cancer Research Center (DKFZ) Heidelberg, Department of Radiation Oncology and OncoRay, University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Germany.
authors.forename: Mechthild
authors.initials: M
authors.lastname: Krause
authors.affiliation: Department of Oncology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Claus
authors.initials: C
authors.lastname: Kamby
authors.affiliation: Department of Oncology, Stavanger University Hospital, Norway.
authors.forename: Ingvil
authors.initials: I
authors.lastname: Mjaaland
authors.affiliation: Department of Oncology, University Hospital of North Norway, Norway; Immunology Research group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Egil S
authors.initials: ES
authors.lastname: Blix
authors.affiliation: Department of Medical Physics, Aalborg University Hospital, Denmark.
authors.forename: Ingelise
authors.initials: I
authors.lastname: Jensen
authors.affiliation: Department of Physics, Hospital of Vejle, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Berg
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Denmark.
authors.forename: Ebbe L
authors.initials: EL
authors.lastname: Lorenzen
authors.affiliation: Department of Oncology, Hospital of Næstved, Denmark.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Taheri-Kadkhoda
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: birgoffe@rm.dk.
authors.forename: Birgitte V
authors.initials: BV
authors.lastname: Offersen
mesh_terms: D001271:Atlases as Topic; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods; D058958:Organs at Risk / Q000000981:diagnostic imaging; D017410:Practice Guidelines as Topic; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed
keywords: Atlas based automated segmentation; Breast cancer; ESTRO consensus guideline; Multi-center study; Target volume delineation; Validation