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Development and validation of AI delineation of the thoracic RTOG organs at risk with deep learning on multi-institutional datasets

摘要Introduction:Accurate contouring of thoracic organs at risk(OARs)is essential for minimizing complications in radiation treatment.Manual contouring of thoracic OARs is not only time-consuming but also prone to substantial user variation.To enhance the efficiency and con-sistency,we developed a unified deep learning(DL)OAR contouring model,DeepOAR,that was trained using multiple partially labeled datasets for segmenting a comprehensive set of thoracic OARs following the Radiation Therapy Oncology Group(RTOG)-guided OAR atlas.This DL model supports the segmentation of six required and eight optional OARs guided by the NRG-RTOG 1106 trial,providing precise and reproducible OARs contouring that are ready to be used in radiotherapy practice.Materials and methods:Following the OAR contouring recommendation of the NRG-RTOG 1106 trial,we collected and curated three private datasets and two public datasets,comprising a total of 531 patients with partially annotated thoracic OARs.These partially annotated datasets were utilized to develop DeepOAR,which consisted of a shared encoder and 14 separate decoders,with each decoder dedicated to one specific OAR.For model training,we utilized all patients from the two public datasets and 75%of the patients from the private datasets.We reserved the remaining 25%of the private datasets for independent testing.A multi-user study involving 21 radiation oncologists was conducted on 40 randomly selected patients from the independent testing dataset to evaluate the clinical applicability of DeepOAR.The Dice coefficient score(DSC)and average surface distance(ASD)were computed to evaluate the quantitative delineation performance of the model.Results:DeepOAR outperformed nnUNet(the benchmark medical segmentation model)across all 14 OARs,achieving mean DSC and ASD values of 88.4%and 1.0 mm,respectively,in the in-dependent testing set.Multi-user validation demonstrated that 89.7%of DeepOAR-generated OARs were clinically acceptable or required only minor revisions.A comparison using two randomly selected patients showed that the delineation variability of DeepOAR was significantly smaller than the inter-user variation among radiation oncologists.Human editing of DeepOAR's predictions could further improve OAR delineation accuracy by an average of 3%increase in DSC and 40%reduction in ASD while significantly reducing the workload of radiation oncologists for contouring 14 thoracic OARs by an average of 77.0%.Conclusion:We developed DeepOAR,a DL-based unified contouring model trained using multiple partially labeled datasets,to delineate a comprehensive set of 14 thoracic OARs following the RTOG-guided OAR atlas.Both qualitative and quantitative results demonstrated the strong clinical applicability of DeepOAR for the OAR delineation process in thoracic cancer radiotherapy workflows,along with improved efficiency,comprehensiveness,and quality.

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作者单位 Department of Radiation Oncology,The First Affiliated Hospital,Zhejiang University,Hangzhou Zhejiang 310003,China [1] DAMO Academy,Alibaba Group,New York NY 10014,USA [2] Department of Radiation Oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300070,China [3] Department of Radiation Oncology,The First Affiliated Hospital,Wenzhou Medical University,Wenzhou Zhejiang 325000,China [4] Department of Radiation Oncology,Taizhou Hospital,Taizhou Zhejiang 317000,China [5] Department of Radiation Oncology,Jiangsu Cancer Hospital,Nanjing Jiangsu 210019,China [6] Department of Radiation Oncology,Nanjing Drum Tower Hospital,Nanjing Jiangsu 210008,China [7] Department of Radiation Oncology,Shanxi Cancer Hospital,Taiyuan Shanxi 030013,China [8] Department of Radiation Oncology,Jinan JunXin Med,Jinan Shandong 250001,China [9] Department of Radiation Oncology,The First Hospital of Lanzhou University,Lanzhou Gansu 730000,China [10] Department of Radiation Oncology,Kiang Wu Hospital,Macau SAR 999078,China [11] Department of Radiation Oncology,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China [12] Department of Radiotherapy,Cancer Hospital & Institute;Cancer Hospital of China Medical University;Department of Radiotherapy,Cancer Hospital of Dalian University of Technology;Faculty of Medicine,Dalian University of Technology,Shenyang Liaoning 110042,China [13] Department of Radiation Oncology,Zhejiang Cancer Hospital,Hangzhou Zhejiang 310022,China [14] Department of Radiation Oncology,Tongji Hospital Tongji Medical College of HUST,Wuhan Hubei 430030,China [15] Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Department of Oncology;Shanghai Medical College,Fudan University;Shanghai Key Laboratory of Radiation Oncology,Shanghai 200032,China [16] Department of Radiation Oncology,Shengli Oilfield Central Hospital,Dongying Shandong 257034,China [17] Department of Radiation Oncology,Shenzhen People's Hospital(The Second Clinical Medical College,Jinan University;The First Affiliated Hospital,Southern University of Science and Technology)Shenzhen,Guangdong 518020,China [18] DAMO Academy,Alibaba Group,Hangzhou Zhejiang 310023,China;Hupan Lab,Hangzhou,Hangzhou Zhejiang 311121,China [19] DAMO Academy,Alibaba Group,Hangzhou Zhejiang 310023,China;Johns Hopkins University,Baltimore MD 21205,USA [20] LinkingMed,Beijing 100094,China [21] Department of Clinical Oncology,School of Clinical Medicine,LKS Faculty of Medicine,The University of Hong Kong and University of Hong Kong-Shenzhen Hospital,Hong Kong SAR 999077,China [22]
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DOI 10.1016/j.intonc.2024.12.001
发布时间 2026-07-21(万方平台首次上网日期,不代表论文的发表时间)
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