title: Prospective randomized double-blind study of atlas-based organ-at-risk autosegmentation-assisted radiation planning in head and neck cancer.
abstract: OBJECTIVE
  Target volumes and organs-at-risk (OARs) for radiotherapy (RT) planning are manually defined, which is a tedious and inaccurate process. We sought to assess the feasibility, time reduction, and acceptability of an atlas-based autosegmentation (AS) compared to manual segmentation (MS) of OARs.
  
  
  METHODS
  A commercial platform generated 16 OARs. Resident physicians were randomly assigned to modify AS OAR (AS+R) or to draw MS OAR followed by attending physician correction. Dice similarity coefficient (DSC) was used to measure overlap between groups compared with attending approved OARs (DSC=1 means perfect overlap). 40 cases were segmented.
  
  
  RESULTS
  Mean ± SD segmentation time in the AS+R group was 19.7 ± 8.0 min, compared to 28.5 ± 8.0 min in the MS cohort, amounting to a 30.9% time reduction (Wilcoxon p<0.01). For each OAR, AS DSC was statistically different from both AS+R and MS ROIs (all Steel-Dwass p<0.01) except the spinal cord and the mandible, suggesting oversight of AS/MS processes is required; AS+R and MS DSCs were non-different. AS compared to attending approved OAR DSCs varied considerably, with a chiasm mean ± SD DSC of 0.37 ± 0.32 and brainstem of 0.97 ± 0.03.
  
  
  CONCLUSIONS
  Autosegmentation provides a time savings in head and neck regions of interest generation. However, attending physician approval remains vital.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Biomedical Informatics, University of Texas Health Science Center, Houston, USA.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Musaddiq
authors.initials: M
authors.lastname: Awan
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Randa
authors.initials: R
authors.lastname: Tao
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Koay
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Boehling
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Grant
authors.affiliation: School of Biomedical Informatics, University of Texas Health Science Center, Houston, USA.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Gary Brandon
authors.initials: GB
authors.lastname: Gunn
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Phan
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Abdallah Sherif Radwan
authors.initials: AS
authors.lastname: Mohamed
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Texas Graduate School of Biomedical Sciences, Houston, USA. Electronic address: cdfuller@mdanderson.org.
authors.forename: Clifton David
authors.initials: CD
authors.lastname: Fuller
mesh_terms: D000704:Analysis of Variance; D001270:Cervical Atlas; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D058958:Organs at Risk / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Atlas-based autosegmentation; Autocontouring; Automatic segmentation; Head and neck; Normal tissue; Organs-at-risk