Cardio-pulmonary substructure segmentation of radiotherapy computed tomography images using convolutional neural networks for clinical outcomes analysis.

Abstract

Background and purposeRadiation dose to the cardio-pulmonary system is critical for radiotherapy-induced mortality in non-small cell lung cancer. Our goal was to automatically segment substructures of the cardio-pulmonary system for use in outcomes analyses for thoracic cancers. We built and validated a multi-label Deep Learning Segmentation (DLS) model for accurate auto-segmentation of twelve cardio-pulmonary substructures.Materials and methodsThe DLS model utilized a convolutional neural network for segmenting substructures from 217 thoracic radiotherapy Computed Tomography (CT) scans. The model was built in the presence of variable image characteristics such as the absence/presence of contrast. We quantitatively evaluated the final model against expert contours for a hold-out dataset of 24 CT scans using Dice Similarity Coefficient (DSC), 95th Percentile of Hausdorff Distance and Dose-volume Histograms (DVH). DLS contours of an additional 25 scans were qualitatively evaluated by a radiation oncologist to determine their clinical acceptability.ResultsThe DLS model reduced segmentation time per patient from about one hour to 10 s. Quantitatively, the highest accuracy was observed for the Heart (median DSC = (0.96 (0.95–0.97)). The median DSC for the remaining structures was between 0.81 and 0.93. No statistically significant difference was found between DVH metrics of the auto-generated and manual contours (p-value 0.69). The expert judged that, on average, 85% of contours were qualitatively equivalent to state-of-the-art manual contouring.ConclusionThe cardio-pulmonary DLS model performed well both quantitatively and qualitatively for all structures. This model has been incorporated into an open-source tool for the community to use for treatment planning and clinical outcomes analysis.