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  1. Fulltext Preliminary survey of 3D image-guided brachytherapy for cervical cancer at representative hospitals in Asian countries
    Okonogi N, Wakatsuki M, Mizuno H, Fukuda S, Cao J, Kodrat H, et al.
    J Radiat Res, 2020 Jul 06;61(4):608-615.
    PMID: 32367130 DOI: 10.1093/jrr/rraa025
    3D image-guided brachytherapy (3D-IGBT) has become a standard therapy for cervical cancer. However, the use of 3D-IGBT is limited in East and Southeast Asia. This study aimed to clarify the current usage patterns of 3D-IGBT for cervical cancer in East and Southeast Asia. A questionnaire-based survey was performed in 11 countries within the framework of the Forum for Nuclear Cooperation in Asia. The questionnaire collected the treatment information of patients with cervical cancer who underwent 3D-IGBT. The cumulative external beam radiotherapy and 3D-IGBT doses were summarized and normalized to a biological equivalent dose of 2 Gy per fraction (EQD2) using a linear-quadratic model. Of the 11 institutions representing the participating countries, six (55%) responded to the questionnaire. Overall, data of 36 patients were collected from the six institutions. Twenty-one patients underwent whole-pelvic irradiation and 15 underwent whole-pelvic irradiation with central shielding. Patients received a median of four treatment sessions of 3D-IGBT (range, 2-6). All 3D-IGBT sessions were computed tomography (CT)-based and not magnetic resonance image-based. The median doses to the high-risk clinical target volume D90, bladder D2cc, rectum D2cc and sigmoid colon D2cc were 80.9 Gy EQD2 (range, 58.9-105.9), 77.7 Gy EQD2 (range, 56.9-99.1), 68.0 Gy EQD2 (range, 48.6-90.7) and 62.0 Gy EQD2 (range, 39.6-83.7), respectively. This study elucidated the current patterns of 3D-IGBT for the treatment of cervical cancer in East and Southeast Asia. The results indicate the feasibility of observational studies of CT-based 3D-IGBT for cervical cancer in these countries.
  2. Potential of E-Learning Interventions and Artificial Intelligence-Assisted Contouring Skills in Radiotherapy: The ELAISA Study
    Rasmussen ME, Akbarov K, Titovich E, Nijkamp JA, Van Elmpt W, Primdahl H, et al.
    JCO Glob Oncol, 2024 Aug;10:e2400173.
    PMID: 39236283 DOI: 10.1200/GO.24.00173
    PURPOSE: Most research on artificial intelligence-based auto-contouring as template (AI-assisted contouring) for organs-at-risk (OARs) stem from high-income countries. The effect and safety are, however, likely to depend on local factors. This study aimed to investigate the effects of AI-assisted contouring and teaching on contouring time and contour quality among radiation oncologists (ROs) working in low- and middle-income countries (LMICs).

    MATERIALS AND METHODS: Ninety-seven ROs were randomly assigned to either manual or AI-assisted contouring of eight OARs for two head-and-neck cancer cases with an in-between teaching session on contouring guidelines. Thereby, the effect of teaching (yes/no) and AI-assisted contouring (yes/no) was quantified. Second, ROs completed short-term and long-term follow-up cases all using AI assistance. Contour quality was quantified with Dice Similarity Coefficient (DSC) between ROs' contours and expert consensus contours. Groups were compared using absolute differences in medians with 95% CIs.

    RESULTS: AI-assisted contouring without previous teaching increased absolute DSC for optic nerve (by 0.05 [0.01; 0.10]), oral cavity (0.10 [0.06; 0.13]), parotid (0.07 [0.05; 0.12]), spinal cord (0.04 [0.01; 0.06]), and mandible (0.02 [0.01; 0.03]). Contouring time decreased for brain stem (-1.41 [-2.44; -0.25]), mandible (-6.60 [-8.09; -3.35]), optic nerve (-0.19 [-0.47; -0.02]), parotid (-1.80 [-2.66; -0.32]), and thyroid (-1.03 [-2.18; -0.05]). Without AI-assisted contouring, teaching increased DSC for oral cavity (0.05 [0.01; 0.09]) and thyroid (0.04 [0.02; 0.07]), and contouring time increased for mandible (2.36 [-0.51; 5.14]), oral cavity (1.42 [-0.08; 4.14]), and thyroid (1.60 [-0.04; 2.22]).

    CONCLUSION: The study suggested that AI-assisted contouring is safe and beneficial to ROs working in LMICs. Prospective clinical trials on AI-assisted contouring should, however, be conducted upon clinical implementation to confirm the effects.

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