eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2020
vol. 12
 
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abstract:
Original paper

Inter-observer and intra-observer variability in reporting vaginal dose points for cervical cancer in high-dose-rate brachytherapy

Nuria Carrasco
1
,
Jose Chimeno
1
,
Mar Adrià-Mora
1
,
María José Pérez-Calatayud
1
,
Blanca Ibáñez
1
,
Vicente Carmona
1
,
Francisco Celada
1
,
Jose Gimeno
1
,
Françoise Lliso
1
,
José Pérez-Calatayud
1

1.
Radiotherapy Department, La Fe Polytechnic and University Hospital, Valencia, Spain
J Contemp Brachytherapy 2020; 12, 2: 139–146
Online publish date: 2020/04/17
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Purpose
The ICRU 89 recommends reporting a set of vaginal dose points for cervical cancer treatments in order to quantify the goodness of implant. This vaginal dose reporting method for combined external beam radiotherapy and brachytherapy has been adopted by the EMBRACE II study protocol. Large variations in dose between patients and centers have been reported. The aim of this study was to determine possible discrepancies with consensus observers from the same institution. Therefore, the inter- and intra-observer variability were analyzed.

Material and methods
For five patients, five experienced observers reported dose at the proposed vaginal points twice. The effect of inter- and intra-observer variations on total dose was analyzed by estimating biologically equivalent dose EQD2 (/ = 3 Gy). Coefficient of variation (CV) was used to provide a measure of data dispersion as a proportion to the mean.

Results
The maximum inter-observer deviation among all patients and all points ranged from 0.5 Gy to 24.1 Gy in EQD2. The higher inter-observer discrepancies were found at points at 3 o’clock and at 6 o’clock, with respect to ovoids. In case of the maximum intra-observer deviation, it ranged from 0.5 Gy to 14.2 Gy, with higher deviation points at 12 o’clock and 9 o’clock, with respect to ovoids.

Conclusions
There is a need to ensure consistency in vaginal points reporting. The impact of the dosimetric inter- and intra-observer variability should also be considered when dealing with dose tolerances and limits due to the potential dose gradient.

keywords:

brachytherapy, cervix, EMBRACE II, ICRU 89, inter-observer

 
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