{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T10:56:33Z","timestamp":1740135393359,"version":"3.37.3"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union and the State of Hungary, co-financed by the European Social Fund","award":["EFOP-3.6.1-16-2016-00008","EFOP-3.6.1-16-2016-00008"],"award-info":[{"award-number":["EFOP-3.6.1-16-2016-00008","EFOP-3.6.1-16-2016-00008"]}]},{"DOI":"10.13039\/501100015269","name":"Hungarian Government","doi-asserted-by":"crossref","award":["VKSZ 12-1-2013-0012","VKSZ 12-1-2013-0012"],"award-info":[{"award-number":["VKSZ 12-1-2013-0012","VKSZ 12-1-2013-0012"]}],"id":[{"id":"10.13039\/501100015269","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Radiotherapy is a standard treatment option for breast cancer, but it may lead to significant late morbidity, including radiation heart damage. Breast irradiation performed individually in the supine or prone position may aid in minimizing the irradiation dose to the heart and LAD coronary artery. A series of CT scans and therapy plans are needed in both positions for the \u2018gold standard\u2019 decision on the preferable treatment position. This method is expensive with respect to technology and physician workload.<\/jats:p>\n                <jats:p>Our ultimate goal is to develop a predictive tool to identify the preferable treatment position using easily measurable patient characteristics. In this article, we describe the details of how model building and consequently validation of the best model are done.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Different models were used: both logistic regression and multiple linear regressions were used to estimate the LAD mean dose difference (the difference between the mean dose to the LAD in the supine position versus prone position); predicted dose differences were analysed compared to the \u2018gold standard\u2019 values, and the best model was selected accordingly. The final model was checked by random cross-validation. In addition to generally used measures (ROC and Brier score), decision curves were employed to evaluate the performance of the models.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>ROC analysis demonstrated that none of the predictors alone was satisfactory. Multiple logistic regression models and the linear regression model lead to high values of net benefit for a wide range of threshold probabilities. Multiple linear regression seemed to be the most useful model. We also present the results of the random cross-validation for this model (i.e. sensitivity of 80.7% and specificity of 87.5%).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Decision curves proved to be useful to evaluate our models. Our results indicate that any of the models could be implemented in clinical practice, but the linear regression model is the most useful model to facilitate the radiation treatment decision. In addition, it is in use in everyday practice in the Department of Oncotherapy, University of Szeged, Hungary.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-019-0927-4","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T20:44:43Z","timestamp":1572468283000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-9242","authenticated-orcid":false,"given":"Ferenc","family":"R\u00e1rosi","sequence":"first","affiliation":[]},{"given":"Krisztina","family":"Boda","sequence":"additional","affiliation":[]},{"given":"Zsuzsanna","family":"Kah\u00e1n","sequence":"additional","affiliation":[]},{"given":"Zolt\u00e1n","family":"Varga","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2019,10,29]]},"reference":[{"key":"927_CR1","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.radonc.2011.06.016","volume":"100","author":"P McGale","year":"2011","unstructured":"McGale P, Darby SC, Hall P, Adolfsson J, Bengtsson NO, Bennet AM, et al. Incidence of heart disease in 35,000 women treated with radiotherapy for breast cancer in Denmark and Sweden. Radiother Oncol. 2011;100:167\u201375.","journal-title":"Radiother Oncol"},{"key":"927_CR2","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.radonc.2010.08.010","volume":"100","author":"N Andratschke","year":"2011","unstructured":"Andratschke N, Maurer J, Molls M, Trott KR. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention. Radiother Oncol. 2011;100:160\u20136.","journal-title":"Radiother Oncol"},{"key":"927_CR3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.radonc.2014.04.009","volume":"112","author":"C Shah","year":"2014","unstructured":"Shah C, Badiyan S, Berry S, et al. Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy. Radiother Oncol. 2014;112:9\u201316.","journal-title":"Radiother Oncol"},{"issue":"11","key":"927_CR4","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1016\/j.clon.2015.06.007","volume":"27","author":"C.W. Taylor","year":"2015","unstructured":"Taylor C.W.,-Kirby A.M. Cardiac Side-effects From Breast Cancer Radiotherapy. Clinicalm Oncology 2015; 27: 621\u2013629.","journal-title":"Clinical Oncology"},{"key":"927_CR5","doi-asserted-by":"publisher","first-page":"3880","DOI":"10.1245\/s10434-016-5503-x","volume":"23","author":"C Shah","year":"2016","unstructured":"Shah C, Tendulkar R, Smile T. el al. Adjuvant radiotherapy in early-stage breast Cancer: evidence-based options. Ann Surg Oncol. 2016;23:3880\u201390.","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"927_CR6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3109\/0284186X.2013.781674","volume":"53","author":"Z Varga","year":"2014","unstructured":"Varga Z, Cserhati A, Rarosi F, et al. Individualized positioning for maximum heart protection during breast irradiation. Acta Oncol. 2014;53(1):58\u201364.","journal-title":"Acta Oncol"},{"issue":"3","key":"927_CR7","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.radonc.2017.12.021","volume":"126","author":"Z Kahan","year":"2018","unstructured":"Kahan Z, Rarosi F, Gaal S, et al. A simple clinical method for predicting the benefit of prone vs. supine positioning in reducing heart exposure during left breast radiotherapy. Radiother Oncol. 2018;126(3):487\u201392.","journal-title":"Radiother Oncol"},{"key":"927_CR8","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.radonc.2010.05.014","volume":"96","author":"AM Kirby","year":"2010","unstructured":"Kirby AM, Evans PM, Donovan EM, Convery HM, Haviland JS, Yarnold JR. Prone versus supine positioning for whole and partial-breast radiotherapy: a comparison of non-target tissue dosimetry. Radiother Oncol. 2010;96:178\u201384.","journal-title":"Radiother Oncol"},{"key":"927_CR9","doi-asserted-by":"publisher","first-page":"2236","DOI":"10.1200\/JCO.2006.09.1041","volume":"25","author":"SC Formenti","year":"2007","unstructured":"Formenti SC, Gidea-Addeo D, Goldberg JD, Roses DF, Guth A, Rosenstein BS, et al. Phase I\u2013II trial of prone accelerated intensity modulated radiation therapy to the breast to optimally spare normal tissue. J Clin Oncol. 2007;25:2236\u201342.","journal-title":"J Clin Oncol"},{"key":"927_CR10","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.radonc.2006.08.014","volume":"82","author":"J Buijsen","year":"2007","unstructured":"Buijsen J, Jager JJ, Bovendeerd J, Voncken R, Borger JH, Boersma LJ, et al. Prone breast irradiation for pendulous breasts. Radiother Oncol. 2007;82:337\u201340.","journal-title":"Radiother Oncol"},{"key":"927_CR11","doi-asserted-by":"publisher","first-page":"5341","DOI":"10.1118\/1.3483264","volume":"37","author":"X Zhao","year":"2010","unstructured":"Zhao X, Wong EK, Wang Y, Lymberis S, Wen B, Formenti S, et al. A support vector machine (SVM) for predicting preferred treatment position in radiotherapy of patients with breast cancer. Med Phys. 2010;37:5341\u201350.","journal-title":"Med Phys"},{"key":"927_CR12","doi-asserted-by":"publisher","first-page":"902","DOI":"10.1016\/j.ijrobp.2012.01.040","volume":"84","author":"SC Lymberis","year":"2012","unstructured":"Lymberis SC, Dewyngaert JK, Parhar P, Chhabra AM, Fenton-Kerimian M, Chang J, et al. Prospective assessment of optimal individual position (prone versus supine) for breast radiotherapy: volumetric and dosimetric correlations in 100 patients. Int J Radiat Oncol Biol Phys. 2012;84:902\u20139.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"927_CR13","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1001\/2012.jama.10759","volume":"308","author":"SC Formenti","year":"2012","unstructured":"Formenti SC, DeWyngaert JK, Jozsef G, Goldberg JD. Prone vs supine positioning for breast cancer radiotherapy. JAMA. 2012;308:861\u20133.","journal-title":"JAMA"},{"key":"927_CR14","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ijrobp.2008.10.045","volume":"75","author":"Z Varga","year":"2009","unstructured":"Varga Z, Hidegh\u00e9ty K, Mez\u0151 T, Nikol\u00e9nyi A, Thurz\u00f3 L, Kah\u00e1n Z. Individual positioning: a comparative study of adjuvant breast radiotherapy in the prone versus supine position. Int J Radiat Oncol Biol Phys. 2009;75:94\u2013100.","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"927_CR15","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1259\/bjr\/12497075","volume":"84","author":"MC Aznar","year":"2011","unstructured":"Aznar MC, Korreman SS, Pedersen AN, Persson GF, Josipovic M, Specht L. Evaluation of dose to cardiac structures during breast irradiation. Br J Radiol. 2011;84:743\u20136.","journal-title":"Br J Radiol"},{"key":"927_CR16","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/S0360-3016(03)00723-5","volume":"57","author":"KL Griem","year":"2003","unstructured":"Griem KL, Fetherston P, Kuznetsova M, Foster GS, Shott S, CHU J, et al. Three-dimensional photon dosimetry: a comparison of treatment of the intact breast in the supine and prone position. Int J Radiation Oncology Biol Phys. 2003;57:891\u20139.","journal-title":"Int J Radiation Oncology Biol Phys"},{"key":"927_CR17","doi-asserted-by":"publisher","DOI":"10.1002\/0471249688","volume-title":"Categorical data analysis","author":"A Agresti","year":"2002","unstructured":"Agresti A. Categorical data analysis. 2nd ed. New York: Wiley-Interscience; 2002.","edition":"2"},{"issue":"7","key":"927_CR18","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1373\/clinchem.2004.031823","volume":"50","author":"NA Obuchowski","year":"2004","unstructured":"Obuchowski NA, Lieber ML, Wians FH. ROC curves in clinical chemistry: uses, misuses, and possible solutions. Clin Chem. 2004;50(7):1118\u201325.","journal-title":"Clin Chem"},{"issue":"6","key":"927_CR19","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0272989X06295361","volume":"26","author":"AJ Vickers","year":"2006","unstructured":"Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Mak. 2006;26(6):565\u201374.","journal-title":"Med Decis Mak"},{"issue":"4","key":"927_CR20","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1198\/000313007X247643","volume":"61","author":"SG Baker","year":"2007","unstructured":"Baker SG, Kramer BS. Peirce, Youden, and receiver operating characteristic curves. Am Stat. 2007;61(4):343\u20136.","journal-title":"Am Stat"},{"issue":"8","key":"927_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v061.i08","volume":"61","author":"M Lopez-Raton","year":"2014","unstructured":"Lopez-Raton M, Cadarso-Suarez C, Rodriguez-Alvarez MX, Gude-Sampedro F. OptimalCutpoints: an R package for selecting optimal Cutpoints in diagnostic tests. J Stat Softw. 2014;61(8):1\u201336.","journal-title":"J Stat Softw"},{"issue":"1","key":"927_CR22","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","volume":"21","author":"EW Steyerberg","year":"2010","unstructured":"Steyerberg EW, Vickers AJ, Cook NR, et al. Assessing the performance of prediction models a framework for traditional and novel measures. Epidemiology. 2010;21(1):128\u201338.","journal-title":"Epidemiology."},{"key":"927_CR23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1175\/1520-0493(1950)078<0001:VOFEIT>2.0.CO;2","volume":"78","author":"GW Brier","year":"1950","unstructured":"Brier GW. Verification of forecasts expressed in terms of probability. Mon Wea Rev. 1950;78:1\u20133.","journal-title":"Mon Wea Rev"},{"key":"927_CR24","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1126\/science.ns-4.93.453-a","volume":"4","author":"CS Peirce","year":"1884","unstructured":"Peirce CS. The numerical measure of the success of predictions. Science. 1884;4:453\u20134.","journal-title":"Science"},{"key":"927_CR25","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s00066-014-0606-4","volume":"190","author":"F W\u00fcrschmidt","year":"2014","unstructured":"W\u00fcrschmidt F, Stoltenberg S, Kretschmer M, Petersen C. Incidental dose to coronary arteries is higher in prone than in supine whole breast irradiation. A dosimetric comparison in adjuvant radiotherapy of early stage breast cancer. Strahlenther Onkol. 2014;190:563\u20138.","journal-title":"Strahlenther Onkol"},{"key":"927_CR26","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1056\/NEJMoa1209825","volume":"368","author":"SC Darby","year":"2013","unstructured":"Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987\u201398.","journal-title":"N Engl J Med"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0927-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12911-019-0927-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-019-0927-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T00:06:12Z","timestamp":1603843572000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-019-0927-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,29]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["927"],"URL":"https:\/\/doi.org\/10.1186\/s12911-019-0927-4","relation":{},"ISSN":["1472-6947"],"issn-type":[{"type":"electronic","value":"1472-6947"}],"subject":[],"published":{"date-parts":[[2019,10,29]]},"assertion":[{"value":"31 January 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Institutional Review Board of the University of Szeged (registration number 185\/2012), and all enrolled patients have provided their written informed consent to participate in the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The manuscript does not contain any individual person\u2019s data in any form.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"204"}}