{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:04:16Z","timestamp":1784178256125,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"\n Background<\/jats:title>\n Consistent clinical target volume (CTV) delineation is vital for breast cancer radiotherapy. While organs-at-risk definitions are increasingly automated, manual CTV delineation of complex post-surgical volumes remains highly observer-dependent, potentially compromising treatment homogeneity.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To quantify inter-observer discrepancies in postoperative breast cancer CTV contouring among regional oncologists and to qualitatively analyze the reasons for these contouring discrepancies to promote standardization and quality assurance.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Based on CT datasets of two representative post-surgical breast cancer cases (BCS and MRM), 22 frontline radiation oncologists from regional municipal hospitals independently contoured the required CTVs. Inter-observer contouring discrepancies across these manual target volumes were quantitatively evaluated via Dice similarity coefficients (DSC) and Hausdorff distances (HD) against a consensus reference standard established through a two-expert consensus workflow.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 20 completed datasets, each for both the BCS and MRM cases, were successfully retrieved and analyzed. The large volumes achieved the highest overlap (\n CTVp_breast<\/jats:italic>\n and\n CTVp_thoracic wall<\/jats:italic>\n DSC mean: 0.80\u00a0\u00b1\u00a00.07 and 0.63\u00a0\u00b1\u00a00.08, respectively), though mean 95% Hausdorff distances (HD\n 95<\/jats:sub>\n ) were elevated at 42.84\u00a0\u00b1\u00a050.62 mm and 45.73\u00a0\u00b1\u00a060.44 mm. Post-BCS focal volumes (\n CTV_tb<\/jats:italic>\n and\n CTV_boost<\/jats:italic>\n ) showed intermediate overlap (both DSC mean: 0.56) but restricted boundary deviations (mean HD\n 95<\/jats:sub>\n : 11.51\u00a0mm and 19.94\u00a0mm). For nodal stations, consistency was moderate for the supraclavicular volume (\n CTVn_L4<\/jats:italic>\n DSC mean: 0.57\u00a0\u00b1\u00a00.15, HD\n 95<\/jats:sub>\n : 26.21\u00a0\u00b1\u00a015.08 mm) but dropped substantially for axillary Level III (\n CTVn_L3<\/jats:italic>\n DSC mean: 0.38\u00a0\u00b1\u00a00.26, HD\n 95<\/jats:sub>\n : 37.95\u00a0\u00b1\u00a037.94 mm) and internal mammary nodes (\n CTVn_IMN<\/jats:italic>\n DSC mean: 0.42\u00a0\u00b1\u00a00.14, HD\n 95<\/jats:sub>\n : 42.67\u00a0\u00b1\u00a025.70 mm).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Delineation consistency is acceptable for large volumes (\n CTVp_breast<\/jats:italic>\n and\n CTVp_thoracic wall<\/jats:italic>\n ) but poor for regional nodal stations, demonstrating that standardized anatomical training is crucial to improve radiotherapy uniformity.\n <\/jats:p>\n 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