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. 2011 Jan 1;79(1):10-8.
doi: 10.1016/j.ijrobp.2009.10.058. Epub 2010 Apr 24.

Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer

Mary Feng  1 , Jean M Moran, Todd Koelling, Aamer Chughtai, June L Chan, Laura Freedman, James A Hayman, Reshma Jagsi, Shruti Jolly, Janice Larouere, Julie Soriano, Robin Marsh, Lori J Pierce
Affiliations

Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer

Mary Feng et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: Cardiac toxicity is an important sequela of breast radiotherapy. However, the relationship between dose to cardiac structures and subsequent toxicity has not been well defined, partially due to variations in substructure delineation, which can lead to inconsistent dose reporting and the failure to detect potential correlations. Here we have developed a heart atlas and evaluated its effect on contour accuracy and concordance.

Methods and materials: A detailed cardiac computed tomography scan atlas was developed jointly by cardiology, cardiac radiology, and radiation oncology. Seven radiation oncologists were recruited to delineate the whole heart, left main and left anterior descending interventricular branches, and right coronary arteries on four cases before and after studying the atlas. Contour accuracy was assessed by percent overlap with gold standard atlas volumes. The concordance index was also calculated. Standard radiation fields were applied. Doses to observer-contoured cardiac structures were calculated and compared with gold standard contour doses. Pre- and post-atlas values were analyzed using a paired t test.

Results: The cardiac atlas significantly improved contour accuracy and concordance. Percent overlap and concordance index of observer-contoured cardiac and gold standard volumes were 2.3-fold improved for all structures (p < 0.002). After application of the atlas, reported mean doses to the whole heart, left main artery, left anterior descending interventricular branch, and right coronary artery were within 0.1, 0.9, 2.6, and 0.6 Gy, respectively, of gold standard doses.

Conclusions: This validated University of Michigan cardiac atlas may serve as a useful tool in future studies assessing cardiac toxicity and in clinical trials which include dose volume constraints to the heart.

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Conflict of interest statement

Conflicts of Interest Notification

No actual or potential conflicts of interest exist.

Figures

Figure 1
Figure 1
Cardiac atlas, without intravenous contrast. Contours are illustrated in the right column, with unmarked images provided in left column for reference. The key for figures 1 and 2 are the same.
Figure 2
Figure 2
Cardiac atlas, with intravenous contrast. Contours are illustrated in the right column, with unmarked images provided in left column for reference.
Figure 2
Figure 2
Cardiac atlas, with intravenous contrast. Contours are illustrated in the right column, with unmarked images provided in left column for reference.
Figure 3
Figure 3
Improvement in cardiac substructure delineation consistency with the use of the cardiac atlas. Panels 1 and 3 show pre-atlas contours of 7 observers on 2 representative cardiac slices without intravenous contrast. The whole heart, right coronary artery, and left anterior descending coronary artery are displayed. Panels 2 and 4 show post-atlas contours on the same cardiac slices. Panels 5–8 show representative slices with intravenous contrast. The whole heart, right coronary artery, left anterior descending coronary artery, and right and left ventricles are displayed. Panels 5 and 7 are pre-atlas, and 6 and 8 are post-atlas. Notice the improvement in consistency, especially in cardiac vessel delineation.
See this image and copyright information in PMC

References

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