Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer

Mary Feng, Jean M. Moran, Todd Koelling, Aamer Chughtai, June L. Chan, Laura Freedman, James A. Hayman, Reshma Jagsi, Shruti Jolly, Janice Larouere, Julie Soriano, Robin Marsh, Lori J. Pierce

Research output: Contribution to journalArticlepeer-review

361 Scopus citations


Purpose: Cardiac toxicity is an important sequela of breast radiotherapy. However, the relationship between dose to cardiac structures and subsequent toxicity has not been well defined, partially due to variations in substructure delineation, which can lead to inconsistent dose reporting and the failure to detect potential correlations. Here we have developed a heart atlas and evaluated its effect on contour accuracy and concordance. Methods and Materials: A detailed cardiac computed tomography scan atlas was developed jointly by cardiology, cardiac radiology, and radiation oncology. Seven radiation oncologists were recruited to delineate the whole heart, left main and left anterior descending interventricular branches, and right coronary arteries on four cases before and after studying the atlas. Contour accuracy was assessed by percent overlap with gold standard atlas volumes. The concordance index was also calculated. Standard radiation fields were applied. Doses to observer-contoured cardiac structures were calculated and compared with gold standard contour doses. Pre- and post-atlas values were analyzed using a paired t test. Results: The cardiac atlas significantly improved contour accuracy and concordance. Percent overlap and concordance index of observer-contoured cardiac and gold standard volumes were 2.3-fold improved for all structures (p < 0.002). After application of the atlas, reported mean doses to the whole heart, left main artery, left anterior descending interventricular branch, and right coronary artery were within 0.1, 0.9, 2.6, and 0.6 Gy, respectively, of gold standard doses. Conclusions: This validated University of Michigan cardiac atlas may serve as a useful tool in future studies assessing cardiac toxicity and in clinical trials which include dose volume constraints to the heart.

Original languageEnglish (US)
Pages (from-to)10-18
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number1
StatePublished - Jan 1 2011
Externally publishedYes


  • Breast cancer
  • Cardiac atlas
  • Cardiac dysfunction
  • Normal-tissue sparing
  • Thoracic radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research


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