AI勾画危及器官对鼻咽癌放疗计划剂量优化的影响  

Application of artificial intelligence to auto-segmentation organ at risk in radiotherapy for nasopharyngeal carcinoma

作　　者：李陆军[1] 游雁[1] 谢金莲[1] 高健全[1] LI Lujun;YOU Yan;XIE Jinlian;GAO Jianquan(Department of Oncology,Wuzhou Red Cross Hospital,Guangxi Wuzhou 543000,China)

机构地区：[1]梧州市红十字会医院肿瘤科,广西梧州543000

出　　处：《现代肿瘤医学》2023年第15期2899-2903,共5页Journal of Modern Oncology

基　　金：广西壮族自治区梧州市科技计划项目(编号:202002140)。

摘　　要：目的:探讨PV-iCurve人工智能(artificial intelligence,AI)勾画系统勾画的危及器官(organ at risk,OAR)直接应用于鼻咽癌放疗计划设计优化的可行性。方法:52例鼻咽癌病例纳入本研究。以医生手工勾画的危及器官(OAR-M)为参考,通过戴斯相似系数(Dice similarity coefficient,DSC)、体积差异(volume difference,VD)两个指标去评估PV-iCurve人工智能勾画系统自动勾画的危及器官(OAR-A)的几何准确性。基于OAR-M优化生成计划Plan-M,基于OAR-A优化生成计划Plan-A。比较Plan-A与Plan-M两组计划靶区PCTV2、PGTV_(nx)的适形度指数(conformity index,CI)和均匀性指数(heterogeneity index,HI),并比较两组计划的危及器官受照剂量。结果:脑干、脊髓、左右眼球、口腔、下颌骨、左右腮腺、喉等体积较大的危及器官,AI勾画结果的DSC值均在0.7以上,VD值更接近0;而左右晶体、左右视神经、视交叉等体积较小的危及器官,AI勾画结果的DSC值基本都在0.7以下,VD值也更大。PCTV2适形度Plan-A与Plan-M两组计划对比为0.84±0.02 vs 0.84±0.02(P>0.05);PGTV_(nx)适形度Plan-A与Plan-M两组计划对比为0.84±0.04 vs 0.86±0.02(P<0.05),PGTV_(nx)均匀性Plan-A与Plan-M两组计划对比为0.07±0.02 vs 0.06±0.02(P<0.05)。危及器官受照剂量方面,Plan-A的OAR-M与Plan-M的OAR-M受照剂量对比情况,除下颌骨和左侧视神经外,其余OAR-M的受照剂量Plan-A均高于Plan-M,脊髓、口腔、左腮腺、喉、左右晶体等6个OAR-M两组计划对比P<0.05,差异有统计学意义。结论:PV-iCurve人工智能勾画系统在头颈部大体积危及器官的勾画准确性较高,小体积危及器官则有所欠缺。将OAR-A直接用于调强放疗计划的设计优化,会导致真实的危及器官受照剂量升高,增加正常组织发生并发症的概率。为了能够准确反映危及器官的受照剂量,建议在应用于鼻咽癌调强放疗计划设计之前,对危及器官勾画的准确性进行检查修改。Objective:To explore the feasibility of using automatic segmentation of organ at risk(OARs)by PV-iCurve artificial intelligence(AI)system in treatment planning for nasopharyngeal carcinoma.Methods:52 nasopharyngeal carcinoma cases were included in this study,taking manual segmentation of OARs(OARs-M)by radiotherapist as reference standard,Dice similarity coefficient(DSC)and volume difference(VD)were used to evaluate the geometric accuracy of PV-iCurve AI system for automatic segmentation of OARs(OARs-A).Plans-M were optimized based on OARs-M,and Plans-A were optimized based on OARs-A.To compare the conformity index(CI)and heterogeneity index(HI)of PCTV2 and PGTV_(nx) between Plans-A and Plans-M,and compare the OARs absorbed dose between the two groups.Results:For brainstem,spinal cord,eye,oral cavity,mandible,parotid,larynx and other large-sized OARs of AI auto-segmentation,the DSC values were all above 0.7,and the VD values were closer to 0.For lens,optic nerve,optic chiasma and other small-sized OARs of AI auto-segmentation,the DSC values were all below 0.7,and the VD values were farther away from 0.Compare the CI of PCTV2 of Plan-A and of Plan-M:0.84±0.02 vs 0.84±0.02(P>0.05).Compare the CI of PGTV_(nx) of Plan-A and of Plan-M:0.84±0.04 vs 0.86±0.02(P<0.05).Compare the HI of PGTV_(nx) of Plan-A and of Plan-M:0.07±0.02 vs 0.06±0.02(P<0.05).In terms of OAR absorbed dose,compared with the absorbed dose of OAR-M of Plan-M,the absorbed dose of other OAR-M except the mandible and left optic nerve was higher in Plan-A,and the difference between the two groups of six OAR-M,such as spinal cord,oral cavity,left parotid gland,larynx,left and right lens,was statistically significant(P<0.05).Conclusion:The AI system is a high accuracy in segmentation large-sized OARs in the head and neck,but it is lacking in small-sized OARs.Using OAR-A in intensity-modulated radiotherapy will lead to high dose of OAR-M,which will increase the probability of complications in normal tissues.In order to accurately reflect the absorbed

关 键 词：人工智能 危及器官 鼻咽癌 自动勾画 

分 类 号：R730.55[医药卫生—肿瘤]