Assessing inter-observer variability in prostate and GTV segmentation on mpMRI: A comparison between radiation...

Accurate delineation of the prostate and intraprostatic gross tumor volume (GTV) on multiparametric MRI (mpMRI) is critical for radiation therapy planning, particularly for focal dose escalation strategies. However, interpretation of mpMRI can be challenging and prone to inter-observer variability, especially among radiation oncologists (ROs) who may have limited training in prostate MRI interpretation. In addition, because many patients do not undergo diagnostic mpMRI before treatment, radiologist input is often absent during treatment planning, which can compromise accurate GTV delineation.

To evaluate approaches for improving focal prostate GTV delineation on mpMRI for radiotherapy planning, by assessing the impact of radiology reports on ROs contours, and comparing the performance of an automated segmentation tool (AIRC) with radiologists' contours as a potential replacement when radiologist input is unavailable.

Twenty patients underwent mpMRI at our institution. Delineation of the prostate gland and GTV was performed by ROs in two phases. In the first phase, ROs segmented both structures with access only to biopsy results, indicating positive core locations. In the second phase, they repeated the segmentation with access to the radiology report. AIRC segmented both structures as well, using the same images as made available to the ROs. Lesion detection performance was evaluated using sensitivity and positive predictive value (PPV). Segmentations were compared to consensus contours from two radiologists using the STAPLE algorithm. Similarity metrics computed included Dice similarity coefficient (DSC), Hausdorff distance (HD), distance from center, and relative volume difference.

Prostate gland segmentation showed minimal inter-observer variability and high agreement with the reference, with a mean DSC of $0.89\pm 0.02$ for ROs and $0.90\pm 0.03$ for AIRC. In contrast, GTV segmentation demonstrated substantial variability and a high number of false positives and missed lesions when ROs lacked access to the radiology report. PPV significantly improved during the second attempt with access to the radiology report ( $p=0.03$ ), and similarity metrics improved significantly across all measures ( ). Sensitivity also increased in the second attempt, although not significantly ( $p=0.0625$ ). AIRC performance was comparable to the ROs' first attempt.

High inter-observer variability in GTV segmentation was observed when ROs lacked access to the radiology report, underscoring the difficulty of mpMRI interpretation. Providing radiology reports and establishing standardized guidelines for mpMRI interpretation may improve segmentation accuracy and consistency. An Automated segmentation tool could facilitate the first step in the planning workflow by assisting ROs in target definition.