Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Daniëlle B.P. Eekers*, Dario Di Perri, Erik Roelofs, Alida Postma, Jeanette Dijkstra, Thankamma Ajithkumar, Claire Alapetite, Malin Blomstrand, Neil G. Burnet, Valentin Calugaru, Inge Compter, Ida E.M. Coremans, Semi Harrabi, Alberto Iannalfi, Yvonne L.B. Klaver, Maarten Lambrecht, Alejandra Méndez Romero, Frank Paulsen, Beate Timmermann, Pavel VitekHiske L. van der Weide, Gillian A. Whitfield, Petra Witt Nyström, Jaap Zindler, Dirk de Ruysscher, Johannes Langendijk, Damien C. Weber, Esther G.C. Troost

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

29 Citations (Scopus)

Abstract

Background and purpose: To update the digital online atlas for organs at risk (OARs) delineation in neuro-oncology based on high-quality computed tomography (CT) and magnetic resonance (MR) imaging with new OARs. Materials and methods: In this planned update of the neurological contouring atlas published in 2018, ten new clinically relevant OARs were included, after thorough discussion between experienced neuro-radiation oncologists (RTOs) representing 30 European radiotherapy-oncology institutes. Inclusion was based on daily practice and research requirements. Consensus was reached for the delineation after critical review. Contouring was performed on registered CT with intravenous (IV) contrast (soft tissue & bone window setting) and 3 Tesla (T) MRI (T1 with gadolinium & T2 FLAIR) images of one patient (1 mm slices). For illustration purposes, delineation on a 7 T MRI without IV contrast from a healthy volunteer was added. OARs were delineated by three experienced RTOs and a neuroradiologist based on the relevant literature. Results: The presented update of the neurological contouring atlas was reviewed and approved by 28 experts in the field. The atlas is available online and includes in total 25 OARs relevant to neuro-oncology, contoured on CT and MRI T1 and FLAIR (3 T & 7 T). Three-dimensional (3D) rendered films are also available online. Conclusion: In order to further decrease inter- and intra-observer OAR delineation variability in the field of neuro-oncology, we propose the use of this contouring atlas in photon and particle therapy, in clinical practice and in the research setting. The updated atlas is freely available on www.cancerdata.org.

Original languageEnglish
Pages (from-to)259-265
Number of pages7
JournalRadiotherapy and Oncology
Volume160
DOIs
Publication statusPublished - 1 Jul 2021

Bibliographical note

Funding Information:
DDP is supported by a grant from Fondation Saint-Luc , Belgium. NGB is supported by the National Institute for Health Research Cambridge Biomedical Research Centre .

Funding Information:
DDP is supported by a grant from Fondation Saint-Luc, Belgium. NGB is supported by the National Institute for Health Research Cambridge Biomedical Research Centre. The authors sincerely thank: Lene Haldbo-Classen, MD PhD, Department of Radiotherapy, Aarhus University Hospital, for sharing her expertise in delineating the frontal lobe, Roel Germ Wanders, technician Maastro, for his help with processing the image data, and Noel Bauer, MD PhD, Department of Ophthalmology, Maastricht University Medical Centre+, for his help delineating the reconstructed fovea and macula. The 7 Tesla MRI was supported by the Brains Unlimited Pioneer Fund of the Limburg University Fund/SWOL (S.2013.1.011). We confirm that we have read the journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. The work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. The manuscript is in line with the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals and aim for the inclusion of representative human populations (sex, age and ethnicity) as per those recommendations. The terms sex and gender are used correctly. The privacy rights of human subjects were always observed.

Funding Information:
The 7 Tesla MRI was supported by the Brains Unlimited Pioneer Fund of the Limburg University Fund/SWOL (S.2013.1.011).

Publisher Copyright:
© 2021

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