Development and Validation of a Deep Learning Algorithm for Auto-delineation of Clinical Target Volume and Organs at Risk in Cervical Cancer Radiotherapy.

The delineation of the clinical target volume (CTV) is a crucial, laborious and subjective step in cervical cancer radiotherapy. The aim of this study was to propose and evaluate a novel end-to-end convolutional neural network (CNN) for fully automatic and accurate CTV in cervical cancer.A total of 237 computed tomography (CT) scans of patients with locally advanced cervical cancer were collected and evaluated. A novel 2.5D CNN network, called DpnUNet, was developed for CTV delineation and further applied for CTV and organ-at-risk (OAR) delineation simultaneously. Comprehensive comparisons and experiments were performed. The mean Dice similarity coefficient (DSC), 95th percentile Hausdorff distance (95HD) and subjective evaluation were used to assess the performance of this method.The mean DSC and 95HD values were 0.86 and 5.34mm for the delineated CTVs. The clinical experts' subjective assessments showed that 90% of the predicted contours were acceptable for clinical usage. The mean DSC and 95HD values were 0.91 and 4.05mm for bladder, 0.85 and 2.16mm for bone marrow, 0.90 and 1.27mm for left femoral head, 0.90 and 1.51mm for right femoral head, 0.82 and 4.29mm for rectum, 0.85 and 4.35mm for bowel bag, 0.82 and 4.96mm for spinal cord respectively. The average delineation time for one patient's CT images was within 15 seconds.The experimental results demonstrate that the CTV and OARs delineated for cervical cancer by DpnUNet was in close agreement with the ground truth. DpnUNet could significantly reduce the radiation oncologists' contouring time.