A cardiac contouring atlas for radiotherapy
Open accessAbstract
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 ( d → H , 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 d → H , avg ) was 1.5–2.2mm for left ventricular segments and 1.3–5.1mm for coronary artery segments. This spatial variation resulted in <1Gy dose variation for most regimens and segments, but 1.2–21.8Gy 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.
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The heart is the hardest of the three structures to segment in breast radiotherapy data because it is not always fully visible in the CT scan and contouring practices vary across treatment lateralities.
“This makes sense: it is the hardest of the three structures to segment in breast radiotherapy data because it is not always fully visible in the CT scan and contouring practices vary across treatment lateralities. 27”
From Uncertainty quantification of U‐Net based segmentation tool using conformal prediction (2026) · cites this paper as [27]
The Background and Discussion (pages unavailable in our copy) describe cardiac substructures as challenging to contour reproducibly on radiotherapy CT scans. The paper does not compare the heart with the other two structures in the claim, say that the whole heart is not always fully visible, or attribute contouring difficulty to practices varying by treatment laterality. (LLM, conf=0.85)
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Self-citation
- Authors
- Duane, F., Aznar, M. C., Bartlett, F., Cutter, D. J., Darby, S. C., Jagsi, R., Lorenzen, E. L., McArdle, O., McGale, P., Myerson, S., Rahimi, K., Vivekanandan, S., Warren, S., & Taylor, C. W.
- Affiliations
- University of Oxford (GB)
- Queen Alexandra Hospital (GB)
- University of Michigan (US)
- Odense University Hospital (DK)
- St. Luke's Hospital (IE)
- The George Institute for Global Health (GB)
- University of Birmingham (GB)
- Corresponding author
- Duane, Frances
- ORCID
- Venue
- Radiotherapy and Oncology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 122
- Issue
- 3
- Pages
- 416-422
- ISSN
- 0167-8140 (ISSN-L)
- PMC
- PMC5356506
- OpenAlex
- W2591100698
- Cited by
- 308
- References
- 24
- Citations by year
- 2026: 31 · 2025: 32 · 2024: 44 · 2023: 35 · 2022: 44 · 2021: 43 · 2020: 35 · 2019: 19 · 2018: 22 · 2017: 3
- FWCI
- 20.37
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Radiotherapy and Oncology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by)
- Funders
- Medical Research Council
- Cancer Research UK (C8225/A21133, RE/13/1/30181, C5255/A15935)
- British Heart Foundation Centre for Research Excellence
- National Institute for Health Research
- Topics
- Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
- Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Medical Image Segmentation Techniques
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
- Keywords
- left ventricle segmentation, coronary artery segmentation, cardiac radiotherapy, breast cancer radiotherapy, heart dose
- MeSH terms
- Breast Neoplasms, Coronary Vessels, Female, Heart, Heart Ventricles, Humans, Radiotherapy Planning, Computer-Assisted, Tomography, X-Ray Computed
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