Jose Moreno, 

Muath Ayyad, Amber Coffey (Group7) 

Dos 711: Research Methodology in Medical Dosimetry I 

04/08/2021 

                                                            Research Proposal 

Title: Medical Dosimetrist perceptions about the efficiency of auto-contouring during treatment

planning.  

Literature Review Summary: In the last 20 years, auto-contouring software has been

developing in the area of atlas-based methods and deep learning algorithms. It is imperative that

contouring of organs at risk (OAR) and target volumes be as accurate as possible.

However,  the quality and time spent on contouring strongly depends on the experience of the

radiation oncologist and medical dosimetrist.1 As part of the medical dosimetrist’s job,

contouring is essential to the time saving and efficient workflow of treatment

planning. Despite many auto-contoured OAR and target structures still require manual

corrections to be made clinically acceptable, many studies show efficient and time saving ability

compared to full manual contouring. 1 

Advancements in computerized treatment planning systems (TPSs) have been substantial,

as evidence by the multiple tools refined to create an improved and more sophisticated

plan. Computer-aided delineation (AD) algorithms are widely available and can save time by

reducing the need for manual-delineation (MD).2 Although accuracy of distinguishing dose to

each structure is a key benefit in auto-contouring, several auto-contouring programs vary

in  accuracy. The atlas-based approach uniquely relies on the availability of one or more CT

series of a specific anatomical district, which has been contoured by an expert physician

following clinical guidelines.3 The goal of this software is to perform a deformable registration of

the atlas subject over to transfer to the CT series that is being contoured. Studies show that

contours obtained through atlas-based algorithms can require minor or major editing.  

The main advantage of deep learning methods is that they automatically generate the

most suitable models.4 Deep learning methods can be trained by passing a large set of contoured

images, through convolution neural networks (CNN). This process allows the algorithm for auto-

contouring methods to vary in its consistency of post-processing contouring technique. While

some findings indicate that atlas-based algorithms are yet to replace the human observer in

contouring tasks such as soft tissue in the pelvis region, it does set the stage for assessing and

deploying progressively improved tools.5 There are mixed results in terms of overall efficiency

with atlas contouring methods, in which depend on anatomical regions. 

It is possible the automation of contouring can save time while in the first phase of

treatment planning by offering the ability to generate accurate organ contours swiftly which

would ordinarily would have been considered time consuming. The problem is that time and

efficiency are diminished during the treatment planning process through manual contouring.

Many factors point toward a future of taking advantage of auto-contouring tools with continued

advancements improving the speed of treatment planning. The purpose of the study is to

investigate perceptions of how auto-contouring software impacts efficiency during the treatment

planning process. Researchers will survey the impact of auto-contouring during the treatment

planning process by looking at consistency, available auto contouring programs and the overall

differences with manual contouring. 

Problem Statement: The problem is that time and efficiency are diminished during the

treatment planning process through manual contouring. 

 

Purpose: The Purpose of the study is to investigate perceptions of how auto-contouring software

impacts efficiency during the treatment planning process. 

Research Questions: Research questions that were used to guide the study were (Q1) How

does auto-contouring impact the length of time to complete the overall treatment planning

process? (Q2) What impact does auto-contouring have on consistency issues during the treatment

planning process? (Q3) Is atlas-based auto-contouring efficient for contouring organs at

risk? (Q4) Does deep learning auto-contouring adapt to the user for auto-contouring

capabilities. (Q5) Dose the accuracy of auto-contouring hinders or excel the overall planning

process? 

 
 References: 

1. Vaassen F, Hazelaar C, Vaniqui A, et al. Evaluation of measures for

assessing timesaving of automatic organ-at-risk segmentation in radiotherapy.  Phys

Imaging  Radiat Oncol. 2020;13(P1-6):1-6.  https://doi.org/10.1016/j.phro.2019.12.001. 

2. Aliotta E, Nourzadeh H, Choi W, Leandro Alves VG, Siebers JV. An Automated

Workflow to Improve Efficiency in Radiation Therapy Treatment Planning by Prioritizing

Organs at Risk. Adv  Radiat Oncol. 2020;5(6):1324-1333. Published 2020 Jun

25.   https://doi.org/10.1016/j.adro.2020.06.012. 

3. Casati M, Piffer S, Calusi S, et al. Methodological approach to create an atlas using a

commercial auto-contouring software. J Appl Clin Med Phys. 2020;21(12):219-

230.  https://doi.org/10.1002/acm2.13093. 

4. Ahn SH, Yeo AU, Kim KH, et al. Comparative clinical evaluation of atlas and deep-

learning-based auto-segmentation of organ structures in liver cancer. Radiat Oncol.

2019;14(1):213. Published 2019 Nov 27.  https://doi.org/10.1186/s13014-019-1392-z. 

5. Jackson P, Kron T, Hardcastle N. A future of automated image contouring with machine

learning in radiation therapy. J Med  Radiat Sci. 2019;66(4):223-

225. https://doi.org/10.1002/jmrs.365.