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Clinical evaluation of atlas-based auto-segmentation in breast and nodal radiotherapy

Welgemoed, Camarie, Spezi, Emiliano ORCID:, Riddle, Pippa, Gooding, Mark J., Gujral, Dorothy, McLauchlan, Ruth and Aboagye, Eric O. 2023. Clinical evaluation of atlas-based auto-segmentation in breast and nodal radiotherapy. British Journal of Radiology 96 (1149) , 20230040. 10.1259/bjr.20230040

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Objectives: Accurate contouring of anatomical structures allows for high-precision radiotherapy planning, targeting the dose at treatment volumes and avoiding organs at risk. Manual contouring is time-consuming with significant user variability, whereas auto-segmentation (AS) has proven efficiency benefits but requires editing before treatment planning. This study investigated whether atlas-based AS (ABAS) accuracy improves with template atlas group size and character-specific atlas and test case selection. Methods and materials: One clinician retrospectively contoured the breast, nodes, lung, heart, and brachial plexus on 100 CT scans, adhering to peer-reviewed guidelines. Atlases were clustered in group sizes, treatment positions, chest wall separations, and ASs created with Mirada software. The similarity of ASs compared to reference contours was described by the Jaccard similarity coefficient (JSC) and centroid distance variance (CDV). Results: Across group sizes, for all structures combined, the mean JSC was 0.6 (SD 0.3, p = .999). Across atlas-specific groups, 0.6 (SD 0.3, p = 1.000). The correlation between JSC and structure volume was weak in both scenarios (adjusted R2−0.007 and 0.185). Mean CDV was similar across groups but varied up to 1.2 cm for specific structures. Conclusions: Character-specific atlas groups and test case selection did not improve accuracy outcomes. High-quality ASs were obtained from groups containing as few as ten atlases, subsequently simplifying the application of ABAS. CDV measures indicating auto-segmentation variations on the x, y, and z axes can be utilised to decide on the clinical relevance of variations and reduce AS editing. Advances in knowledge: High-quality ABASs can be obtained from as few as ten template atlases. Atlas and test case selection do not improve AS accuracy. Unlike well-known quantitative similarity indices, volume displacement metrics provide information on the location of segmentation variations, helping assessment of the clinical relevance of variations and reducing clinician editing. Volume displacement metrics combined with the qualitative measure of clinician assessment could reduce user variability.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Engineering
Publisher: British Institute of Radiology
ISSN: 0007-1285
Date of First Compliant Deposit: 5 August 2023
Date of Acceptance: 28 June 2023
Last Modified: 28 Sep 2023 21:48

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