Multi-institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume using planning-CT and FDG-PETCT

Xianghua Ye; Dazhou Guo; Chen-kan Tseng; Jia Ge; Tsung-Min Hung; Ping-Ching Pai; Yanping Ren; Lu Zheng; Xinli Zhu; Ling Peng; Ying Chen; Xiaohua Chen; Chen-Yu Chou; Danni Chen; Jiaze Yu; Yuzhen Chen; Feiran Jiao; Yi Xin; Lingyun Huang; Guotong Xie; Jing Xiao; Le Lu; Senxiang Yan; Dakai Jin; Tsung-Ying Ho

arXiv · 2110.05280

Multi-institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume using planning-CT and FDG-PETCT

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Abstract

Background: The current clinical workflow for esophageal gross tumor volume (GTV) contouring relies on manual delineation of high labor-costs and interuser variability. Purpose: To validate the clinical applicability of a deep learning (DL) multi-modality esophageal GTV contouring model, developed at 1 institution whereas tested at multiple ones. Methods and Materials: We collected 606 esophageal cancer patients from four institutions. 252 institution-1 patients had a treatment planning-CT (pCT) and a pair of diagnostic FDG-PETCT; 354 patients from other 3 institutions had only pCT. A two-streamed DL model for GTV segmentation was developed using pCT and PETCT scans of a 148 patient institution-1 subset. This built model had the flexibility of segmenting GTVs via only pCT or pCT+PETCT combined. For independent evaluation, the rest 104 institution-1 patients behaved as unseen internal testing, and 354 institutions 2-4 patients were used for external testing. We evaluated manual revision degrees by human experts to assess the contour-editing effort. The performance of the deep model was compared against 4 radiation oncologists in a multiuser study with 20 random external patients. Contouring accuracy and time were recorded for the pre-and post-DL assisted delineation process. Results: Our model achieved high segmentation accuracy in internal testing (mean Dice score: 0.81 using pCT and 0.83 using pCT+PET) and generalized well to external evaluation (mean DSC: 0.80). Expert assessment showed that the predicted contours of 88% patients need only minor or no revision. In multi-user evaluation, with the assistance of a deep model, inter-observer variation and required contouring time were reduced by 37.6% and 48.0%, respectively. Conclusions: Deep learning predicted GTV contours were in close agreement with the ground truth and could be adopted clinically with mostly minor or no changes.

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Xianghua Ye, Dazhou Guo, Chen-kan Tseng, Jia Ge, Tsung-Min Hung, Ping-Ching Pai, Yanping Ren, Lu Zheng, Xinli Zhu, Ling Peng, Ying Chen, Xiaohua Chen, Chen-Yu Chou, Danni Chen, Jiaze Yu, Yuzhen Chen, Feiran Jiao, Yi Xin, Lingyun Huang, Guotong Xie, Jing Xiao, Le Lu, Senxiang Yan, Dakai Jin, Tsung-Ying Ho. 2021-10-11. Multi-institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume using planning-CT and FDG-PETCT. https://arxiv.org/abs/2110.05280

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