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. 2018 Feb 14;13(2):e0192124.
doi: 10.1371/journal.pone.0192124. eCollection 2018.

Computer tomography-based body surface area evaluation for drug dosage: Quantitative radiology versus anthropomorphic evaluation

Antoine Iannessi  1 , Hubert Beaumont  2 , Christophe Hebert  3 , Claire Dittlot  4 , Marie Noëlle Falewee  5
Affiliations

Computer tomography-based body surface area evaluation for drug dosage: Quantitative radiology versus anthropomorphic evaluation

Antoine Iannessi et al. PLoS One. .

Abstract

Objective: The measure of body surface area (BSA) is a standard for planning optimal dosing in oncology. This index is derived from a model having questionable performances. In this study, we proposed measurement of BSA from whole body CT images (iBSA). We tested the reliability of iBSA assessments and simulated the impact of our approach on patient chemotherapy dosage planning.

Methods: We first evaluated accuracy and precision of iBSA in measuring 14 phantom and 11 CT test-retest images.Secondly, we retrospectively analyzed 26 whole body PET-CT scans to evaluate inter-method variability between iBSA and the most used anthropomorphic models, notably the "Du Bois and Du Bois" model. Finally, we simulated the impact on chemotherapy dose planning of capecitabine based on iBSA.

Results: Precision and accuracy of iBSA measurement featured a standard deviation of 1.11% and a mean error of 1.53%. Inter-method variability between iBSA and "Du Bois and Du Bois" assessment featured a standard deviation of 4.11% leading to a reclassification rate of capecitabine of 32.5%.

Conclusions: iBSA could help the oncologist in standardizing assessments for chemotherapy planning. iBSA could also be relevant for applications such as comprehensive body composition and provide a sensitive measurement for changes related to nutritional intake or other metabolism.

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Conflict of interest statement

Competing Interests: Hubert Beaumont is employee at MEDIAN Technologies. All other co-authors have no competing interest to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Image-derived BSA quality assessment.
Left: Original whole body acquisition, Right: corresponding segmentation mask, Bottom: volume rendering. Two reviewers simultaneously compared original whole body scans, CT scans and segmentation masks to report if corrections were needed.
Fig 2
Fig 2. Simulation scheme of re-classification rate calculation according to dose banding adjustment of capecitabine.
N = 1000000 BSA samples were uniformly simulated between 1.2 and 2.5m2. We assessed the ratio of patient (red circle) of different morphology that would have received a different dosage depending on the method used for BSA assessment. We used a table of standard dose according to a dose-banding protocol.
Fig 3
Fig 3. Population of the study.
Distribution of weight (horizontal) and height (vertical) of the 26 patients involved in the study.
Fig 4
Fig 4. Qualification results of image-derived BSA.
a) Accuracy: Box plot of percent relative error in computing BSA of CT phantom. 14 acquisitions of the phantom were repeated with various positions. Median error was 1.54% ranging from -3.3% to 13.06%. b) Precision: Bland Altman plot of test-retest measurement of 11 thoracic and thoracic abdominal patients from the RIDER database.
Fig 5
Fig 5. Inter-method comparison between image-derived BSA and Du Bois formula.
a) Regression of BSA assessments between du Bois & du Bois method and imaging. Twenty-six patients’ data were considered. b) Bland Altman plot of Surface CT against du Bois & du Bois estimation. The relative difference of error reported a SD = 4.11% with a constant bias of 3.6%.
See this image and copyright information in PMC

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