A cardiac contouring atlas for radiotherapy

Background and purpose: The heart is a complex anatomical organ and contouring the cardiac substructures is challenging. This study presents a reproducible method for contouring left ventricular and coronary arterial segments on radiotherapy CT-planning scans. Material and methods: Segments were defined from cardiology models and agreed by two cardiologists. Reference atlas contours were delineated and written guidelines prepared. Six radiation oncologists tested the atlas. Spatial variation was assessed using the DICE similarity coefficient (DSC) and the directed Hausdorff average distance (dH(,avg)). The effect of spatial variation on doses was assessed using six different breast cancer regimens. Results: The atlas enabled contouring of 15 cardiac segments. Inter-observer contour overlap (mean DSC) was 0.60-0.73 for five left ventricular segments and 0.10-0.53 for ten coronary arterial segments. Inter observer contour separation (mean dH,(avg)) was 1.5-2.2 mm for left ventricular segments and 13-5.1 mm for coronary artery segments. This spatial variation resulted in < 1 Gy dose variation for most regimens and segments, but 1.2-21.8 Gy variation for segments close to a field edge. Conclusions: This cardiac atlas enables reproducible contouring of segments of the left ventricle and main coronary arteries to facilitate future studies relating cardiac radiation doses to clinical outcomes. (C) 2017 The Author(s). Published by Elsevier Ireland Ltd.