Automatic Contour Refinement for Deep Learning Auto-segmentation of Complex Organs in MRI-guided Adaptive Radiation Therapy

Purpose: Fast and accurate auto-segmentation on daily images is essential for magnetic resonance imaging (MRI)-guided adaptive radiation therapy (ART). However, the state-of-the-art auto-segmentation based on deep learning still has limited success, particularly for complex structures in the abdomen. This study aimed to develop an automatic contour refinement (ACR) process to quickly correct for unacceptable auto-segmented contours. Methods and Materials: An improved level set-based active contour model (ACM) was implemented for the ACR process and was tested on the deep learning-based auto-segmentation of 80 abdominal MRI sets along with their ground truth contours. The performance of the ACR process was evaluated using 4 contour accuracy metrics: the Dice similarity coefficient (DSC), mean distance to agreement (MDA), surface DSC, and added path length (APL) on the auto-segmented contours of the small bowel, large bowel, combined bowels, pancreas, duodenum, and stomach. Results: A portion (3%-39%) of the corrected contours became practically acceptable per the American Association of Physicists in Medicine Task Group 132 (TG-132) recommendation (DSC > 0.8 and MDA < 3 mm). The best correction performance was seen in the combined bowels, where for the contours with major errors (initial DSC < 0.5 or MDA > 8 mm), the mean DSC increased from 0.34 to 0.59, the mean MDA decreased from 7.02 mm to 5.23 mm, and the APL reduced by almost 20 mm, whereas for the contours with minor errors, the mean DSC increased from 0.72 to 0.79, the mean MDA decreased from 3.35 mm to 3.29 mm, and more than one-third (39%) of the ACR contours became clinically acceptable. The execution time for the ACR process on one subregion was less than 2 seconds using an NVIDIA GTX 1060 GPU. Conclusions: The ACR process implemented based on the ACM was able to quickly correct for some inaccurate contours produced from MRI-based deep learning auto-segmentation of complex abdominal anatomy. The ACR method may be integrated into the auto -segmentation step to accelerate the process of MRI-guided ART. (c) 2022 The Author(s). Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).