Manual contouring in RT planning of organs at risk (OARs) has been prone to significant variability due to a lack of standardized object definitions, leading to imprecision. Although clinical guidelines have been made available, ambiguities in object definitions still exist. Suboptimal object quality and image quality can also significantly impact the quality of object contouring. These issues are particularly problematic when creating robust object models for purposes of auto-contouring. As such, we present more precise definitions of selected OARs in the neck and thorax as an extension of existing guidelines. A prevailing issue is evaluation of auto-contouring methods as a function of input image quality. We propose a new approach to assess the impact of object and image quality upon auto-contouring results. We hypothesize that OAR manual contours still have significant variability from existing guidelines, and object and image quality impact auto-contouring. We first developed precise and computable definitions of the neck and thorax body regions based on anatomical considerations. We then developed precise standardized definitions of a set of key OARs in these body regions by extending object definitions available from recent guidelines. Next, we retrospectively created a database of CT images and manually drawn contours obtained from RT planning in 216 head and neck cancer patients and 200 thoracic cancer patients. A reader examined each image and assigned a quality grade to each 3D object in the image based on a set of pre-specified criteria which included: deviation in body posture and object intensity; presence of image noise, streak artifacts, object shape distortion, and pathology; and lack of object contrast. Using logical predicates, we designed an algorithm to map these quality grades to a numeric quality score for each object in each CT scan, as well as for the scan. Precise object definitions for 11 objects in the neck and 11 objects in the thorax were created. Per our standardized definitions, among all objects in the neck studies, 33.8% were acceptable without modification, 46.9% required minor changes, and 19.3% needed major editing. For the thorax, these rates were 10.5%, 56.17%, and 33.33%, respectively. ∼1% of the scans, considering all objects in each scan, were of high quality as per the above criteria. Results of analysis of an auto-contouring software as a function of the image quality numeric score will be presented at the conference. Precise standardized object definitions are essential to ensure high quality of OAR contours for RT planning. Yet, currently available guidelines are still ambiguous as borne out from our analysis. Suboptimal image quality may also significantly impact the quality of object contouring. We have arrived at more precise definitions of a set of objects in the neck and thorax, and developed a new approach to assess the impact of object and image quality upon auto-contouring results.
Read full abstract