Comparison and consensus guidelines for delineation of clinical target volume for CT- and MR-based brachytherapy in locally advanced cervical cancer

Akila N. Viswanathan*, Beth Erickson, David K. Gaffney, Sushil Beriwal, Sudershan K. Bhatia, Omer Lee Burnett, David P. D'Souza, Nikhilesh Patil, Michael G. Haddock, Anuja Jhingran, Ellen L. Jones, Charles A. Kunos, Larissa J. Lee, Lilie L. Lin, Nina A. Mayr, Ivy Petersen, Primoz Petric, Lorraine Portelance, William Small, Jonathan B. StraussKanokpis Townamchai, Aaron H. Wolfson, Catheryn M. Yashar, Walter Bosch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

159 Scopus citations


Objective: To create and compare consensus clinical target volume (CTV) contours for computed tomography (CT) and 3-Tesla (3-T) magnetic resonance (MR) image-based cervical-cancer brachytherapy.

Methods and Materials: Twenty-three experts in gynecologic radiation oncology contoured the same 3 cervical cancer brachytherapy cases: 1 stage IIB near-complete response (CR) case with a tandem and ovoid, 1 stage IIB partial response (PR) case with tandem and ovoid with needles, and 1 stage IB2 CR case with a tandem and ring applicator. The CT contours were completed before the MRI contours. These were analyzed for consistency and clarity of target delineation using an expectation maximization algorithm for simultaneous truth and performance level estimation (STAPLE), with κ statistics as a measure of agreement between participants. The conformity index was calculated for each of the 6 data sets. Dice coefficients were generated to compare the CT and MR contours of the same case.

Results: For all 3 cases, the mean tumor volume was smaller on MR than on CT (P<.001). The κ and conformity index estimates were slightly higher for CT, indicating a higher level of agreement on CT. The Dice coefficients were 89% for the stage IB2 case with a CR, 74% for the stage IIB case with a PR, and 57% for the stage IIB case with a CR.

Conclusion: In a comparison of MR-contoured with CT-contoured CTV volumes, the higher level of agreement on CT may be due to the more distinct contrast medium visible on the images at the time of brachytherapy. MR at the time of brachytherapy may be of greatest benefit in patients with large tumors with parametrial extension that have a partial or complete response to external beam. On the basis of these results, a 95% consensus volume was generated for CT and for MR. Online contouring atlases are available for instruction at

Original languageEnglish (US)
Pages (from-to)320-328
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Oct 1 2014

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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