Automated Segmentation of Sacral Chordoma and Surrounding Muscles Using Deep Learning Ensemble

Purpose: The manual segmentation of organ structures in radiation oncology treatment planning is a time-consuming and highly skilled task, particularly when treating rare tumors like sacral chordomas. This study evaluates the performance of auto-mated deep learning (DL) models in accurately segmenting the gross tumor volume (GTV) and surrounding muscle structures of sacral chordomas. Methods and Materials: An expert radiation oncologist contoured 5 muscle structures (gluteus maximus, gluteus medius, glu-teus minimus, paraspinal, piriformis) and sacral chordoma GTV on computed tomography images from 48 patients. We trained 6 DL auto-segmentation models based on 3-dimensional U-Net and residual 3-dimensional U-Net architectures. We then imple-mented an average and an optimally weighted average ensemble to improve prediction performance. We evaluated algorithms with the average and standard deviation of the volumetric Dice similarity coefficient, surface Dice similarity coefficient with 2 -and 3-mm thresholds, and average symmetric surface distance. One independent expert radiation oncologist assessed the clinical viability of the DL contours and determined the necessary amount of editing before they could be used in clinical practice. Results: Quantitatively, the ensembles performed the best across all structures. The optimal ensemble (volumetric Dice simi-larity coefficient, average symmetric surface distance) was (85.5 +/- 6.4, 2.6 +/- 0.8; GTV), (94.4 +/- 1.5, 1.0 +/- 0.4; gluteus maxi-mus), (92.6 +/- 0.9, 0.9 +/- 0.1; gluteus medius), (85.0 +/- 2.7, 1.1 +/- 0.3; gluteus minimus), (92.1 +/- 1.5, 0.8 +/- 0.2; paraspinal), and (78.3 +/- 5.7, 1.5 +/- 0.6; piriformis). The qualitative evaluation suggested that the best model could reduce the total muscle and tumor delineation time to a 19-minute average. Conclusions: Our methodology produces expert-level muscle and sacral chordoma tumor segmentation using DL and ensemble modeling. It can substantially augment the streamlining and accuracy of treatment planning and represents a critical step toward automated delineation of the clinical target volume in sarcoma and other disease sites. (c) 2023 Elsevier Inc. All rights reserved.