# Predicting the Impact of Target Volume Contouring Variations on the Organ at Risk Dose: Results of a Qualitative Survey

This work was [published](https://doi.org/10.1016/j.radonc.2025.110999) in [Radiotherapy and Oncology](https://www.thegreenjournal.com/) (the "Green Journal"), volume 210, article 110999, 2025.

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The accurate delineation of target volumes (TV) and organs-at-risk (OARs) is a cornerstone of radiotherapy planning, directly affecting the balance between tumour control and the preservation of healthy tissue. Contouring remains a critical vulnerability in the workflow, subject to significant inter-observer variability. As auto-contouring shifts the clinician's role from producing contours to reviewing them, it becomes important to understand how well experts can judge the *dosimetric* consequences of contour variations — not just their geometric appearance.

In this study, we surveyed four radiation oncologists and three medical physicists, who evaluated 54 glioblastoma target-volume contour variations across 14 patients. The results revealed **high variability** in their assessments: Cohen's Kappa values ranged from 0.33 to 0.74 (fair to moderate agreement), evaluators misclassified 46% of "no change" cases as "worse", and failed to identify any of the four genuinely "better" contours. The best evaluator reached a precision of 0.63, recall of 0.65, and F1 score of 0.64, while the lowest scored 0.53, 0.43, and 0.35. These findings quantify the limited reliability of manual dosimetric contour assessment and motivate the automated, dose-aware quality-assurance tools developed throughout this work.

## Citation

If you find this work useful, please cite it as:

    @article{willmann2025predicting,
    title={Predicting the impact of target volume contouring variations on the organ at risk dose: results of a qualitative survey},
    author={Willmann, Jonas and Kamath, Amith and Poel, Robert and Riggenbach, Elena and Mose, Lucas and Bertholet, Jenny and Muller, Silvan and Schmidhalter, Daniel and Andratschke, Nicolaus and Ermis, Ekin and Reyes, Mauricio},
    journal={Radiotherapy and Oncology},
    volume={210},
    pages={110999},
    publisher={Elsevier},
    doi={10.1016/j.radonc.2025.110999},
    year={2025}
    }