Image AddedIn this single institution retrospective study, we reviewed 950 consecutive patients with prostate adenocarcinoma receiving definitive radiotherapy between 2011 and 2019, and identified among them 112 patients with anatomic variations (edge cases) seen on simulation CT and/or MRI imaging. These variations included hip arthroplasty, prostate median lobe hypertrophy, so-called “droopy” seminal vesicles, presence of a urinary catheter, and others.

A separate cohort of 19 “normal” cases were randomly selected for inclusion. Prostate, rectum, bladder, and bilateral femoral heads

were manually segmented on all CT simulation images (where present) and were ultimately used clinically for radiation treatment planning.

We leveraged this imaging dataset to assess the comparative performance of deep learning, atlas-based, and model-based autosegmentation methods across both normal and edge case cohorts

Conclusions: Anatomic variation may present challenges to commercial autosegmentation solutions, and such edge cases should be considered both prior to and throughout any clinical implementation.

: https://doi.org/10.1016/j.phro.2023.100413.  In this paper and in the figure on the right, we show the Cross-sectional CT-based anatomy and autosegmentation performance for representative edge cases.

A) Hypertrophic prostate edge case. Each panel depicts a focused excerpt from a single CT scan, centered about two different structures (prostate, bladder) in three different planes (axial, sagittal, coronal). Clinician-delineated “ground truth” contours (MD) for each structure are shown in red, while atlas-based (AB), model-based (MB), and deep-learning based (DL) autosegmented contours are depicted in green, orange, and blue, respectively. Numerical values represent DSC for the corresponding autosegmented volumes compared to MD volumes.

B) So-called “droopy” seminal vesicles edge case. Each panel depicts a focused excerpt from a single CT scan, centered about the prostate in two different planes (axial, sagittal). All colors and labeling are as in Panel A)

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