Use of a novel atlas for muscles of mastication to reduce inter observer variability in head and neck radiotherapy contouring

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Christina Hague
  • William Beasley
  • Lynne Dixon
  • Simona Gaito
  • Kate Garcez
  • Lip W Lee
  • Massimo Maranzano
  • Andrew McPartlin
  • Damian Mullan
  • Andrew J Sykes
  • David Thomson
  • Nick Slevin


PURPOSE/OBJECTIVE(S): Trismus is caused by injury to the masticatory muscles resulting from cancer or its treatment. Contouring these muscles to reduce dose and radiation related trismus can be problematic due to interobserver variability. This study aimed to evaluate the reduction in interobserver variability achievable with a new contouring atlas.

MATERIALS/METHODS: The atlas included: medial and lateral pterygoids (MP, LP), masseter (M) and temporalis (T) muscles, and the temporo-mandibular joint (TMJ). Seven clinicians delineated five paired structures on CT scans from 5 patients without the atlas. After ≥5 weeks, contouring was repeated using the atlas. Using contours generated by the clinicians on the same 5 CT scans as reference, dice similarity coefficient (DSC), mean distance-to-agreement (DTA) and centre of mass (COM) difference were compared with and without the atlas. Comparison was also performed split by training grade. Mean and standard deviation (SD) values were measured.

RESULTS: The atlas reduced interobserver variability for all structures. Mean DTA significantly improved for MP (p = 0.01), M (p < 0.01), T (p < 0.01) and TMJ (p < 0.01). Mean DTA improved using the atlas for the trainees across all muscles, with the largest reduction in variability observed for the T (4.3 ± 7.1 v 1.2 ± 0.4 mm, p = 0.06) and TMJ (2.1 ± 0.7 v 0.8 ± 0.3 mm, p < 0.01). Distance between the COM and interobserver variability reduced in all directions for MP and T.

CONCLUSION: A new atlas for contouring masticatory muscles during radiotherapy planning for head and neck cancer reduces interobserver variability and could be used as an educational tool.

Bibliographical metadata

Original languageEnglish
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Early online date9 Nov 2018
Publication statusPublished - 2018

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