Target Volume Delineation for Partial Breast Radiotherapy Planning: Clinical Characteristics Associated with Low Interobserver Concordance

Purpose To examine variability in target volume delineation for partial breast radiotherapy planning and evaluate characteristics associated with low interobserver concordance. Methods and Materials Thirty patients who underwent planning CT for adjuvant breast radiotherapy formed the study cohort. Using a standardized scale to score seroma clarity and consensus contouring guidelines, three radiation oncologists independently graded seroma clarity and delineated seroma volumes for each case. Seroma geometric center coordinates, maximum diameters in three axes, and volumes were recorded. Conformity index (CI), the ratio of overlapping volume and encompassing delineated volume, was calculated for each case. Cases with CI ≤0.50 were analyzed to identify features associated with low concordance. Results The median time from surgery to CT was 42.5 days. For geometric center coordinates, variations from the mean were 0.5–1.1 mm and standard deviations (SDs) were 0.5–1.8 mm. For maximum seroma dimensions, variations from the mean and SDs were predominantly p p Conclusion Variability in seroma contouring occurred in three dimensions, with the largest variations in the medial–lateral axis. Awareness of clinical features associated with reduced concordance may be applied toward training staff and refining contouring guidelines for partial breast radiotherapy trials.