Exhibit Hall | Forum 9
Purpose: To automate contouring of the elective clinical target volumes (CTVs) and organs at risk (OARs) for head and neck cancer (HNC) patients, treated on MR-Linac, through algorithmic segmentation of magnetic resonance (MR) images via deep convolutional neural networks (CNNs).
Methods: The MOMENTUM Study provides 38 MR T2-weighted scans of HNC patients. A clinician manually contoured the elective CTVs (lymph nodes), spinal cord (SC), parotid glands, and brainstem, referred to as C-ROIs. 34 MR scans together with the C-ROIs were used to train a CNN with a 2D U-Net architecture (Ronneberger et al, 2015). Data augmentation was performed through applying rotation up to range ±3°, zoom up to 10%, and vertical and horizontal shifts up to 10%. The algorithm was tested on the remaining 4 scans. Results were evaluated geometrically using the Dice similarity coefficient (DSC) and dosimetrically by evaluating the effect on the C-ROIs of optimizing new plans using algorithmically derived volumes applying the clinical goals used at our hospital to judge the suitability of clinical plans.
Results: Our results show mean DSC (± SD) of 0.54 ± 0.06 for left nodes, 0.60 ± 0.03 for right nodes, 0.68 ± 0.12 for SC, 0.80 ± 0.14 for left parotid, 0.83 ± 0.02 for right parotid, 0.85 ± 0.03 for brainstem. Dosimetrically we observed that all clinical goals remain satisfied except those judging the minimum dose level to be delivered to 95% and 99% of the elective CTV. Full segmentation executes in the order of 8 seconds.
Conclusion: This study shows the feasibility of using CNNs to automate the contouring of the OARs required for treatment planning of HNC patients on the MR-Linac. Results demonstrate difficulty in contouring the elective CTVs, however, larger datasets are becoming available which shall be used in combination with different approaches to improve contouring accuracy.