A prospective randomized evaluation of AI assisted GTV contouring in head-and-neck radiotherapy
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Published on: June 7, 2015
Mathis E Rasmussen1, Jintao Ren2, Jasper A Nijkamp2
1Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Background:
AI-assisted contouring has demonstrated efficiency and consistency benefits for organs-at-risk in radiotherapy. However, its impact on gross tumor volume (GTV) delineation remains unexplored. The aim of this study was to evaluate AI-assisted GTV contouring in head and neck cancer radiotherapy in an exploratory randomized controlled clinical trial.
Methods:
In this prospective, single-centre, randomized controlled evaluation, patients referred for curative-intent radiotherapy of head-neck cancer were randomized to manual contouring (control) or AI-assisted contouring (intervention) of gross tumor volumes using an in-house developed segmentation model. The primary endpoint was the extent of editing during a blinded multidisciplinary target conference, using normalized Added Path Length (APL). Secondary endpoints included conference duration, self-reported contouring time, and perceived complexity of the cases.
Results:
Between Sept 11, 2023, and Jan 20, 2025, 85 patients were enrolled; 83 were included in the analysis (41 control, 42 AI-assisted). The median difference in APL (AI-assisted minus control, negative favoring the intervention) was -0.02 [-0.32; 0.07] for GTV-T and 0.06 [-0.01; 0.14] for GTV-N. Conference duration, contouring time, and perceived complexity were similar between groups. No adverse events were reported.
Conclusion:
The median difference in APL between groups was consistent with no relevant effect for GTV-T. For GTV-N, however, AI-assisted contouring tended towards more editing during peer review for APL, but not for supplementary contour metrics. No efficiency benefits were demonstrated. Overall, these findings do not indicate a concern, but warrants further research before widespread adoption.
