Atlas-Based Auto-Segmentation Of CT Images In Head And Neck

Cancer; What Is The Best Approach?

1 2
Elekta, CMS, Inc.
Mischa Hoogeman1, Xiao Han2, David Teguh1, Peter Voet1, Terry Wolf2, Lyn
Erasmus MC - Daniel den Hoed Cancer Center Tel: +31 10 439 17 48
Department of Radiation Oncology Fax: +31 10 439 10 12 1145 Corporate Lake Drive
Groene Hilledijk 301 E-mail: m.hoogeman@erasmusmc.nl St. Louis
Hibbard2, Ben Heijmen1, Peter Nowak1, and Peter Levendag1 3075 EA Rotterdam MO 63132, USA
The Netherlands

Introduction The Use of ABAS for Involved Neck Levels Results

The large number of target and critical structures that require manual Figure 1 shows that OARs and neck levels were accurately auto-
delineation in H&N cancer patients make contouring tedious and time Figure 2. Auto-contouring segmented, although some editing of the auto-contours is inevitable.
example for an involved neck
costly. Automated segmentation would lower the burden and allow level (reference contour in The multiple-subject method performed better (see Figs. 1 & 3).
green and multiple-subject
more normal tissues to be included in treatment planning to fully exploit auto-contour in yellow). The Similarity metrics did not or moderately correlate with the accuracy of
muscle was not included in the 2
knowledge on dose-volume effects, use of high-dose IMRT, and auto-contour, because the
the auto-segmentation (median R of 0.2, range 0.0 – 0.7). The mean
inverse planning. The aim of this study was to evaluate a novel atlas- algorithm used N0 necks to Dice coefficient / STSD (mm) of the multiple-subject method was 0.74/2
segment the N+ neck. At the
based automatic segmentation method and to compare two different medial site, some vessels were (salivary glands), 0.67/3 (levels), 0.71/2 (chewing muscles), 0.50/2
not encompassed. Both issues
atlas selection strategies. can be quickly fixed by editing (swallowing muscles), and 0.78/2 (cord/brainstem). Except for levels
the auto-contour.
with invaded muscle, no significant differences were observed in the
Methods & Materials auto-segmentation accuracy in N0 and N+ patients (Fig. 2). Auto-
An experienced staff member manually contoured individual levels I-V
CT data of 10 H&N cancer patients (N0 and N+) was used. The data segmentation of N+ necks could be improved by using a dedicated
(both necks) and twenty OARs (salivary glands, chewing and
showed a considerable inter-patient variability in iv-contrast uptake, atlas for N+ patients.
swallowing muscles, and cord/brainstem). These contours were used
head pose, dental artifacts and use of a tongue depressor.
to construct the atlas and were regarded as a gold standard. Surface-to-Surface Distance and Dice Coefficient
Multiple-Subject Atlas vs. Single-Subject Atlas
The hierarchical atlas registration consisted of 3 steps: linear 8,0

Surf-to-surf distance (mm)

Single subject atlas
registration, object-driven poly-smooth non-linear registration, and Multiple subject atlas
6,0
shape-constrained dense deformable registration. Dice coefficient (0 Figure 3. Comparing
4,0 STSD and Dice
indicating no overlap, 1 is perfect agreement) and the mean surface-to- coefficient for the
2,0
single-subject and
surface distance (STSD) between the auto-segmented structures and multiple-subject
approach. Both metrics
the gold standard were calculated to evaluate the accuracy. Atlas 0,0
quantify the agreement
1,0 between the auto-
selection was studied by relating similarity metrics to the accuracy of
contours and the gold
the auto-segmentation. Two atlas-based auto-segmentation standard. Overall, the

Dice coefficient
multiple-subject
approaches were evaluated (1) selection of the atlas patient with the 0,5 method performed
better (p<0.01; paired
highest similarity metric and (2) combining multiple segmentations of all
t-test).
Figure 1. Examples of single-subject auto-contours (yellow), multiple-subject atlas patients into one segmentation. N+ levels were not used for
auto-contours (turquoise) together with the reference contours (green). Left: 0,0
multiple segmentations and the leave-one-out cross validation method salivary levels chewing swallowing cord /
level II, Middle: Parotid gland, masseter and pterygoid muscle, Right: glands muscles muscles brainstem
Swallowing muscle. was used to remove bias.

Conclusion: Despite the large inter-patient variability in the study population, neck levels and OARs could be accurately auto-segmented. The multiple-subject atlas performed better
than the best single-subject atlas. Some manual editing of auto-segmented contours is inevitable. Nevertheless, the new algorithm for auto-segmentation will substantially reduce the
clinical workload spent on organ segmentation.