Refining Critical Structure Contouring in STereotactic Arrhythmia Radioablation (STAR): Benchmark Results and Consensus Guidelines from the Consortium.

Balgobind, Brian V; Visser, Jorrit; Grehn, Melanie; Marquard Knap, Marianne; de Ruysscher, Dirk; Levis, Mario; Alcantara, Pino; Boda-Heggemann, Judit; Both, Marcus; Cozzi, Salvatore; Cvek, Jakub; Dieleman, Edith M T; Elicin, Olgun; Giaj-Levra, Niccolò; Jumeau, Raphaël; Krug, David; Algara, Manuel; Mayinger, Michael; Mehrhof, Felix; Miszczyk, Marcin; ... (2023). Refining Critical Structure Contouring in STereotactic Arrhythmia Radioablation (STAR): Benchmark Results and Consensus Guidelines from the Consortium. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 189, p. 109949. Elsevier Scientific Publ. Ireland 10.1016/j.radonc.2023.109949

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In patients with recurrent ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) shows promising results. The STOPSTORM consortium was established to investigate and harmonise STAR treatment in Europe. The primary goals of this benchmark study were to standardise contouring of organs at risk (OAR) for STAR, including detailed substructures of the heart, and accredit each participating centre.


Centres within the STOPSTORM consortium were asked to delineate 31 OAR in three STAR cases. Delineation was reviewed by the consortium expert panel and after a dedicated workshop feedback and accreditation was provided to all participants. Further quantitative analysis was performed by calculating DICE similarity coefficients (DSC), median distance to agreement (MDA), and 95th percentile distance to agreement (HD95).


Twenty centres participated in this study. Based on DSC, MDA and HD95, the delineations of well-known OAR in radiotherapy were similar, such as lungs (median DSC=0.96, median MDA=0.1mm and median HD95=1.1mm) and aorta (median DSC=0.90, median MDA=0.1mm and median HD95=1.5mm). Some centres did not include the gastro-oesophageal junction, leading to differences in stomach and oesophagus delineations. For cardiac substructures, such as chambers (median DSC=0.83, median MDA=0.2mm and median HD95=0.5mm), valves (median DSC=0.16, median MDA=4.6mm and median HD95=16.0mm), coronary arteries (median DSC=0.4, median MDA=0.7mm and median HD95=8.3mm) and the sinoatrial and atrioventricular nodes (median DSC=0.29, median MDA=4.4mm and median HD95=11.4mm), deviations between centres occurred more frequently. After the dedicated workshop all centres were accredited and contouring consensus guidelines for STAR were established.


This STOPSTORM multi-centre critical structure contouring benchmark study showed high agreement for standard radiotherapy OAR. However, for cardiac substructures larger disagreement in contouring occurred, which may have significant impact on STAR treatment planning and dosimetry evaluation. To standardize OAR contouring, consensus guidelines for critical structure contouring in STAR were established.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Radiation Oncology

UniBE Contributor:

Eliçin, Olgun


600 Technology > 610 Medicine & health




Elsevier Scientific Publ. Ireland




Pubmed Import

Date Deposited:

13 Oct 2023 12:51

Last Modified:

28 Nov 2023 00:15

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

STOPSTORM consortium STereotactic Arrhythmia Radioablation (STAR) Stereotactic Body Radiotherapy (SBRT) cardiac substructures contouring benchmark organs at risk (OAR) ventricular tachycardia (VT)




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