Geometric and dosimetric analysis of CT- and MR-based automatic contouring for the EPTN contouring atlas in neuro-oncology

Purpose: Atlas-based and deep-learning contouring (DLC) are methods for automatic segmentation of organs-at-risk (OARs). The European Particle Therapy Network (EPTN) published a consensus-based atlas for delineation of OARs in neuro-oncology. In this study, geometric and dosimetric evaluation of automatically-segmented neuro-oncological OARs was performed using CT- and MR-models following the EPTN-contouring atlas. Methods: Image and contouring data from 76 neuro-oncological patients were included. Two atlas-based models (CT-atlas and MR-atlas) and one DLC-model (MR-DLC) were created. Manual contours on registered CT-MR-images were used as ground-truth. Results were analyzed in terms of geometrical (volumetric Dice similarity coefficient (vDSC), surface DSC (sDSC), added path length (APL), and mean slice-wise Hausdorff distance (MSHD)) and dosimetrical accuracy. Distance-to-tumor analysis was performed to analyze to which extent the location of the OAR relative to planning target volume (PTV) has dosimetric impact, using Wilcoxon rank-sum tests. Results: CT-atlas outperformed MR-atlas for 22/26 OARs. MR-DLC outperformed MR-atlas for all OARs. Highest median (95 %CI) vDSC and sDSC were found for the brainstem in MR-DLC: 0.92 (0.88–0.95) and 0.84 (0.77–0.89) respectively, as well as lowest MSHD: 0.27 (0.22–0.39)cm. Median dose differences (?D) were within ± 1 Gy for 24/26(92 %) OARs for all three models. Distance-to-tumor showed a significant correlation for ?Dmax,0.03cc-parameters when splitting the data in = 4 cm and > 4 cm OAR-distance (p < 0.001). Conclusion: MR-based DLC and CT-based atlas-contouring enable high-quality segmentation. It was shown that a combination of both CT- and MR-autocontouring models results in the best quality.