PURPOSE

This study aims to evaluate the performance of Atlas and neural network autosegmentation methods and develop a knowledge-based quality assurance (QA) tool for pediatric craniospinal irradiation (CSI).

METHODS AND MATERIALS

Autosegmentation was performed on 63 CSI patients using 3 methods: Atlas, commercial artificial intelligence (AI), and in-house AI. The performance of these methods was analyzed using 13 quantitative metrics, comprising 6 overlap and 7 distance metrics, across 13 critical organs and a linear mixed-effect model analysis was performed. Additionally, a knowledge-based QA tool was developed by leveraging distinctive computed tomography number distributions from 100 CSI patients for each organ, using the kernel density estimation (KDE) method to ensure robust error detection and validation. The QA tool was tested on 50 CSI cases by comparing baseline KDEs from 100 CSI patients.

RESULTS

The linear mixed-effect analysis showed that the in-house AI outperformed both the Atlas and commercial AI methods in overlap and distance metrics. The in-house AI outperformed the commercial AI with a higher average overlap of 0.01 ± 0.01 and surpassed the Atlas method by 0.02 ± 0.01. In terms of distance metrics, the in-house AI matched the commercial AI (-0.31 ± 0.72 mm) and exceeded the Atlas method by 3.10 ± 0.68 mm. Paired t-tests showed the in-house AI was superior to the Atlas in 13.0% of cases, while the Atlas outperformed the in-house method in 8.9% of comparisons. Similarly, the in-house AI was better than the commercial AI in 35.3% of tests, with the commercial AI outperforming in 32.7%. The QA tool results demonstrated that 100% agreement with baseline KDEs occurred in 46.4% of tests for Atlas, 46.5% for the commercial AI, and 60.7% for the in-house AI.

CONCLUSIONS

The in-house AI excelled over the Atlas and commercial AI methods in autosegmentation accuracy for pediatric CSI patients. Furthermore, a knowledge-based QA tool enables clinicians to detect and correct gross errors in autosegmentation.