Interobserver variability in target definition for stereotactic arrhythmia radioablation
Frontiers in Cardiovascular Medicine, vol. 10, pp. 1267800
Abstract
Background: Stereotactic arrhythmia radioablation (STAR) is a potential new therapy for patients with refractory ventricular tachycardia (VT). The arrhythmogenic substrate (target) is synthesized from clinical and electro-anatomical information. This study was designed to evaluate the baseline interobserver variability in target delineation for STAR. Methods: Delineation software designed for research purposes was used. The study was split into three phases. Firstly, electrophysiologists delineated a well-defined structure in three patients (spinal canal). Secondly, observers delineated the VT-target in three patients based on case descriptions. To evaluate baseline performance, a basic workflow approach was used, no advanced techniques were allowed. Thirdly, observers delineated three predefined segments from the 17-segment model. Interobserver variability was evaluated by assessing volumes, variation in distance to the median volume expressed by the root-mean-square of the standard deviation (RMS-SD) over the target volume, and the Dice-coefficient. Results: Ten electrophysiologists completed the study. For the first phase interobserver variability was low as indicated by low variation in distance to the median volume (RMS-SD range: 0.02-0.02 cm) and high Dice-coefficients (mean: 0.97 ± 0.01). In the second phase distance to the median volume was large (RMS-SD range: 0.52-1.02 cm) and the Dice-coefficients low (mean: 0.40 ± 0.15). In the third phase, similar results were observed (RMS-SD range: 0.51-1.55 cm, Dice-coefficient mean: 0.31 ± 0.21). Conclusions: Interobserver variability is high for manual delineation of the VT-target and ventricular segments. This evaluation of the baseline observer variation shows that there is a need for methods and tools to improve variability and allows for future comparison of interventions aiming to reduce observer variation, for STAR but possibly also for catheter ablation.
Authors 20
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Amsterdam UMC Location University of Amsterdam · Amsterdam Cardiovascular Sciences
Affiliation as printed
Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, Netherlands
Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
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Washington University in St. Louis
Affiliation as printed
Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, United States
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Affiliation as printed
Department of Radiation Oncology, Manchester Academic Health Centre, University of Manchester, Manchester, United Kingdom
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Washington University in St. Louis
Affiliation as printed
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
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Affiliation as printed
Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
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South Tees Hospitals NHS Foundation Trust
Affiliation as printed
Department of Cardiology, South Tees Hospitals NHS Foundation Trust, Middleborough, United Kingdom
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University of California San Diego
Affiliation as printed
Department of Medicine, Division of Cardiology Cardiac Electrophysiology, Cardiovascular Institute, University of California San Diego, San Diego, CA, United States
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Centre Hospitalier Universitaire Vaudois · University of Lausanne
Affiliation as printed
Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Centre Hospitalier Universitaire Vaudois · University of Lausanne
Affiliation as printed
Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Amsterdam UMC Location University of Amsterdam · Amsterdam Cardiovascular Sciences
Affiliation as printed
Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, Netherlands
Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
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Affiliation as printed
Department of Immunity, Infection and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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Affiliation as printed
Section of Cardiac Electrophysiology, Emory University, Atlanta, GA, United States
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Amsterdam Cardiovascular Sciences · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, Netherlands
Department of Cardiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Centre Hospitalier Universitaire de Bordeaux · Electrophysiology and Heart Modeling Institute
Affiliation as printed
Cardiac Arrhythmia Department, IHU LIRYC, Bordeaux University Hospital, Bordeaux, France
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Centre Hospitalier Universitaire de Bordeaux · Electrophysiology and Heart Modeling Institute
Affiliation as printed
Cardiac Arrhythmia Department, IHU LIRYC, Bordeaux University Hospital, Bordeaux, France
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University Medical Center Utrecht
Affiliation as printed
Department of Radiation Oncology, UMC Utrecht, Utrecht, Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Radiation Oncology, Amsterdam UMC, Amsterdam, Netherlands
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Washington University in St. Louis
Affiliation as printed
Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
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Leiden University Medical Center
Affiliation as printed
Department of Radiation Oncology, LUMC, Leiden, Netherlands
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Pieter G. Postema corresponding
Amsterdam UMC Location University of Amsterdam · Amsterdam Cardiovascular Sciences
Affiliation as printed
Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, Netherlands
Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
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