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Research ArticleHead & Neck
Open Access

The Impact of Interactive MRI-Based Radiologist Review on Radiotherapy Target Volume Delineation in Head and Neck Cancer

D. Adjogatse, I. Petkar, M. Reis Ferreira, A. Kong, M. Lei, C. Thomas, S.F. Barrington, C. Dudau, P. Touska, T. Guerrero Urbano and S.E.J. Connor
American Journal of Neuroradiology February 2023, 44 (2) 192-198; DOI: https://doi.org/10.3174/ajnr.A7773
D. Adjogatse
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
dSchool of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
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  • ORCID record for D. Adjogatse
I. Petkar
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
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M. Reis Ferreira
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
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  • ORCID record for M. Reis Ferreira
A. Kong
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
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M. Lei
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
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C. Thomas
bMedical Physics (C.T.)
dSchool of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
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S.F. Barrington
eKing’s College London and Guy’s and St Thomas’ PET Centre (S.F.B.), School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, UK
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C. Dudau
cRadiology (C.D., P.T., S.E.J.C.), Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
fDepartment of Neurororadiology (C.D., S.E.J.C.), King’s College Hospital, London, UK
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P. Touska
cRadiology (C.D., P.T., S.E.J.C.), Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
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T. Guerrero Urbano
aFrom the Departments of Oncology (D.A., I.P., M.R.F., A.K., M.L., T.G.U.)
gFaculty of Dentistry, Oral and Craniofacial Sciences (T.G.U.), King’s College London, London, UK
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S.E.J. Connor
cRadiology (C.D., P.T., S.E.J.C.), Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK
dSchool of Biomedical Engineering and Imaging Sciences (D.A., C.T., S.E.J.C.)
fDepartment of Neurororadiology (C.D., S.E.J.C.), King’s College Hospital, London, UK
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  • FIG 1.
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    FIG 1.

    Examples of volume amendments made at peer review. Selected images show the difference in GTVonc and GTVrad delineations. A and B, T2-weighted axial images show an intermediate-signal left piriform fossa tumor (arrows). Following review of the diffusion-weighted imaging (b = 1000) (single arrow) (C), the contouring on T1-weighted gadolinium-enhanced axial image is expanded from GTVonc (red) to GTVrad (green) (D). T2-weighted axial image demonstrates multiple bilateral lymph nodes. The left submandibular gland (arrow) was initially included in the GTVonc (red) because it was isointense to other pathologic lymph nodes. F, Diffusion-weighted imaging (b = 1000) aided in the identification of the lower signal submandibular gland; hence, it was excluded from GTVrad (green).

  • FIG 2.
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    FIG 2.

    Factors contributing to volume amendments: GTVT and GTVN. 1Changes made following joint discussion between the oncologist and radiologist, eg, inclusion of lymph nodes with borderline pathologic changes. 2Diffusion-weighted MR imaging sequences. 3Tumor volumes described as complex by the oncologist and radiologist at the time of peer review. Includes skull base disease with perineural spread, septate tumor, and postexcisional biopsy changes.

  • FIG 3.
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    FIG 3.

    Boxplots of percentage volume change for GTVT by subsite. Case number 22 and 24 (highlighted as superscript numbers on the box plot of oropharyngeal cancer cases) are outliers in terms of percentage volume change. Case 22: the GTVT was reduced by 24.5% on radiologist review due to the removal of normal oral tongue and normal parapharyngeal fat. Case 24; GTVT increased by 41.4% on radiologist review due to imaging misinterpretation of abnormal deep mucosal disease extent.

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American Journal of Neuroradiology: 44 (2)
American Journal of Neuroradiology
Vol. 44, Issue 2
1 Feb 2023
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D. Adjogatse, I. Petkar, M. Reis Ferreira, A. Kong, M. Lei, C. Thomas, S.F. Barrington, C. Dudau, P. Touska, T. Guerrero Urbano, S.E.J. Connor
The Impact of Interactive MRI-Based Radiologist Review on Radiotherapy Target Volume Delineation in Head and Neck Cancer
American Journal of Neuroradiology Feb 2023, 44 (2) 192-198; DOI: 10.3174/ajnr.A7773

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Interactive MRI Review Impact Radiotherapy Targets
D. Adjogatse, I. Petkar, M. Reis Ferreira, A. Kong, M. Lei, C. Thomas, S.F. Barrington, C. Dudau, P. Touska, T. Guerrero Urbano, S.E.J. Connor
American Journal of Neuroradiology Feb 2023, 44 (2) 192-198; DOI: 10.3174/ajnr.A7773
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