1. Introduction
Radiation therapy (RT) is an effective cancer treatment therapy where high-intensity radiation beams are used to kill cancerous tissues and cells, decreasing the size of the malignant tumor. In the RT treatment workflow, radiation oncologists use the images based on a Computed Tomography (CT) or Magnetic Resonance (MR) dataset saved in the Digital Imaging and Communications in Medicine (DICOM) files to delineate or contour the various anatomical regions or structures of the organ of interest in these imaging datasets and provide appropriate structure names. These physician-identified structures are either Organs at Risk (OARs), Planning Target Volume (PTV), Clinical Target Volume (CTV), Gross Tumor Volume (GTV), or ‘Other’ (all the remaining structures). Based on the particular disease site such as prostate or lung cancer, the radiation oncologist contours all neighboring OARs such as bladder, rectum, bowel, femurs, etc., for prostate cases and heart, spinal cord, both lungs, ribs, etc., for the lung cases. While defining these contours and naming them, we observe a high level of variability in the recorded structure names, which makes it hard to consistently gather data for the same structure contour type across a large population of patients. Inconsistencies in the physician-given structure names are primarily due to the personal choice of the physicians coupled with the variation in policies and systems at different RT clinics.
This issue of disparity between the physician-given structure names is addressed by the American Association of Physicists in Medicine (AAPM), and the American Society for Radiation Oncology (ASTRO) [
1,
2,
3]. It mainly addressed the key challenges in the Radiation structure name standardization process and has released a Task Group 263 (TG-263) report where the standard names for the structures are mentioned. With the availability of the standard structure names, there rises the need to automate the standardization of the structure names. It takes huge amounts of time and labour to manually standardize the structure names which presents a challenge in the clinical world that requires rapid decision-making depending upon the criticality of cancer patients. Hence, automatic prediction of standard structure names is a vital problem to solve both from a clinician’s and an informatician’s point of view. However, there have been limited attempts to automate the structure name standardization process using artificial intelligence (AI) and machine learning (ML) related techniques. Extensive experimentation with various data models and networks is required to elevate the current state-of-the-art in this domain.
From a clinical perspective, our framework has the potential to enable the construction of data pooling tools that can reuse retrospective patient imaging and contouring datasets for tracking patient outcomes, building data registries and clinical trials. Standardized structure names help ensure that all members of the radiation oncology team, including physicians, dosimetrists, and therapists, are using consistent and accurate terminology when identifying and contouring anatomical structures. Furthermore, consistent and accurate contouring of anatomical structures is critical for achieving optimal treatment outcomes in radiation oncology. Standardized structure names can help ensure that all team members are working on the same page, which can help improve treatment accuracy and efficacy.
Author Contributions
Conceptualization, P.B. and P.G.; methodology, P.B. and P.R.; software, P.B. and W.C.S.IV; validation, P.B.; formal analysis, P.B., W.C.S.IV, R.K. and P.G.; investigation, P.B.; resources, W.C.S.IV, R.K., J.P. and P.G.; data curation, W.C.S.IV and S.S.; writing—original draft preparation, P.B.; writing—review and editing, P.B., P.G., W.C.S.IV, P.R., S.S. and J.P.; supervision, R.K., J.P. and P.G.; project administration, R.K., J.P. and P.G.; funding acquisition, R.K., P.G. and J.P. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the US Veterans Health Administration-National Radiation Oncology Program (VHA-NROP). The results, discussions, and conclusions reported in this paper are completely those of the authors and are independent from the funding sources.
Institutional Review Board Statement
Ethical review and approval were waived because this study was considered as secondary data analysis and declared as exempt by the US Veteran’s Health Administration IRB.
Informed Consent Statement
Not applicable.
Data Availability Statement
No new data were created or analyzed in this study. Data sharing is not applicable to this article.
Conflicts of Interest
The authors declare no conflict of interest.
Abbreviations
The following abbreviations are used in this manuscript:
DICOM | Digital Imaging and Communications in Medicine |
OAR | Organ at Risk |
RT | Radiotherapy |
PTV | Planning Target Volume |
VHA | Veterans Health Administration |
VCU | Virginia Commonwealth University |
CT | Computed Tomography |
MR | Magnetic Resonance |
AAPM | American Association of Physicists in Medicine |
ASTRO | American Society for Radiation Oncology |
TG | Task Group |
NLP | Natural Language Processing |
ML | Machine Learning |
AI | Artificial Intelligence |
IRB | Institutional Review Board |
TPS | Treatment Planning System |
ROQS | Radiation Oncology Quality Surveillance Program |
MRI | Magnetic Resonance Imaging |
PET | Positron Emission Tomography |
RT | Radiation Therapy |
BioBERT | Bidirectional Encoder Representations from Transformers for Biomedical Text Mining |
DNN | Deep Neural Network |
CNN | Convolutional Neural Network |
RNN | Recurrent Neural Network |
SRU | Simple Recurrent Unit |
LSTM | Long Short Term Memory |
ResNet | Residual Network |
VGG | Vision Geometry Group |
NROP | National Radiation Oncology Program |
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Figure 1.
Image and structure set data from a single CT slice: (a) Delineation of a bladder (in blue) over the corresponding planning CT image (b) Bitmap representation of the bladder (c) Bony anatomy of the same CT, created with a density-based filter (d) Combination of the structure set and bony anatomy data.
Figure 2.
Pictorial Representation of our Masking Step in the case of (a) images, and (b) doses of Prostate RT Patients.
Figure 3.
Overview of our DNN architecture: (a) General architecture of our 3D Convolution-based network on vision-dose data and 1D CNN on text data, (b) Customized 3D CNN on vision-dose, (c) Customized 3D VGG network on vision-dose, (d) Customized 3D ResNet on vision-dose, (e) Stacked customized 3D VGG Network blocks with nested 3D ResNet blocks inside each block on vision-dose data.
Figure 4.
Bar plots showing (a) the distribution of various data classes in the RT Prostate Structure Naming Dataset, and (b) the variation in the number of samples from the ‘Other’ class in different cases of consideration.
Figure 5.
Line curve showing the variation in F1-Scores of the model with variation in the number of samples from the majority ‘Other’ class.
Figure 6.
Confusion Matrices of the best three predictions for the Prostate Cancer Patients by the F1-Scores are shown in (a) 3D VGG network and 1D CNN without undersampling, (b) 3D ResNet and 1D CNN with 3500 majority class samples, and (c) 3D VGG network and 1D CNN with 2500 majority class samples. Confusion Matrices of the best predictions of the architecture for the Prostate Cancer Patients by the F1-Scores are shown in (d) 3D CNN and 1D CNN with 1500 majority class samples.
Table 1.
Distribution of the Organ structure for the Prostate Cancer Patients.
Standard Names | VHA Physician Given Name Counts | VCU Physician Given Name Counts | Total Physician Given Name Counts | Available Given Name Counts |
---|
Bladder | 609 | 50 | 659 | 519 |
Rectum | 719 | 50 | 769 | 517 |
PTV (Target) | 714 | 38 | 752 | 522 |
Femur_L | 694 | 29 | 723 | 508 |
Femur_R | 700 | 29 | 729 | 515 |
SmallBowel | 250 | 49 | 299 | 145 |
LargeBowel | 341 | 0 | 341 | 234 |
‘Other’ | 11,038 | 980 | 12,018 | 6763 |
Prostate Total | 15,065 | 1225 | 16,290 | 9723 |
Table 2.
Distribution of the Physician Given Structure Names for the Prostate Cancer Patients.
Structure Type | Standard Name | Patient 1 | Patient 2 | Patient 3 |
---|
OAR | LargeBowel | Colon_Sigmoid | - | - |
OAR | Femur_R | Femur_Head_R | RtFemHead | Hip Right |
OAR | Femur_L | Femur_Head_L | LtFemHead | Hip Left |
OAR | Bladder | Bladder | bladder | Bladder |
OAR | Rectum | Rectum | rectum | Rectum |
OAR | SmallBowel | - | bowel | - |
Target | PTV | PTV_7920 | PTV45Gy | PTV 2 |
‘Other’ | “Other” | z post rectum | ptv4cm | Rectum − PTV |
‘Other’ | “Other” | Body | nodalCTVfinal | Prostate + SV |
‘Other’ | “Other” | CTVp | NONPTVBlad | PTV 1 |
‘Other’ | “Other” | CouchInterior | CTVProsSV | Bladder − PTV |
‘Other’ | “Other” | PenileBulb | External | Seminal Vesicles |
‘Other’ | “Other” | Prostate | FinalISO | Seed Marker 1 |
‘Other’ | “Other” | z_rectuminptv | MarkedISO | Dose 104 [%] |
‘Other’ | “Other” | z_dosedec | CTVBst | Seed Marker 3 |
Table 3.
Performance of the CNN-based Models for the Prostate cancer patients during data selection.
Data Modality | Method | Precision (in %) | Recall (in %) | F1-Score (in %) |
---|
struc+ image+ dose+ text | 3D CNN and 1D CNN | 91.93 | 92.93 | 92.42 |
struc+ image+ dose+ text | 3D ResNet and 1D CNN | 92.72 | 93.74 | 93.2 |
struc+ image+ dose+ text | 3D VGG and 1D CNN | 93.51 | 92.99 | 93.19 |
masked image+ masked dose+ text | 3D CNN and 1D CNN | 93.65 | 93.29 | 93.4 |
masked image+ masked dose+ text | 3D ResNet and 1D CNN | 91.05 | 94.83 | 92.76 |
masked image+ masked dose+ text | 3D VGG and 1D CNN | 94.66 | 94.39 | 94.45 |
Table 4.
Model performances for the Prostate cancer patients with varying data modalities.
Masked Image | Masked Dose | Text | Method | Precision (in %) | Recall (in %) | F1-Score (in %) |
---|
✓ | - | - | 3D CNN | 71.75 | 74.81 | 72.99 |
✓ | - | - | 3D ResNet | 73.94 | 74.24 | 73.92 |
✓ | - | - | 3D VGG | 76.19 | 74.46 | 74.82 |
- | ✓ | - | 3D CNN | 74.18 | 70.79 | 72.17 |
- | ✓ | - | 3D ResNet | 74.01 | 62.94 | 66.39 |
- | ✓ | - | 3D VGG | 81.53 | 77.98 | 79.45 |
✓ | ✓ | - | 3D CNN | 93.6 | 91.52 | 91.93 |
✓ | ✓ | - | 3D ResNet | 94.23 | 93.65 | 93.82 |
✓ | ✓ | - | 3D VGG | 93.0 | 94.9 | 93.8 |
- | - | ✓ | 1D CNN | 92.18 | 94.24 | 93.17 |
✓ | - | ✓ | 3D CNN and 1D CNN | 93.31 | 92.49 | 92.83 |
✓ | - | ✓ | 3D ResNet and 1D CNN | 91.33 | 95.18 | 93.15 |
✓ | - | ✓ | 3D VGG and 1D CNN | 92.24 | 91.35 | 91.71 |
- | ✓ | ✓ | 3D CNN and 1D CNN | 91.86 | 93.66 | 92.61 |
- | ✓ | ✓ | 3D ResNet and 1D CNN | 90.13 | 94.97 | 92.29 |
- | ✓ | ✓ | 3D VGG and 1D CNN | 91.82 | 93.42 | 92.54 |
✓ | ✓ | ✓ | 3D CNN and 1D CNN | 93.65 | 93.29 | 93.4 |
✓ | ✓ | ✓ | 3D ResNet and 1D CNN | 91.05 | 94.83 | 92.76 |
✓ | ✓ | ✓ | 3D VGG and 1D CNN | 94.66 | 94.39 | 94.45 |
Table 5.
Model performances for the Prostate cancer patients with variation in the majority class samples.
Total Samples from ‘Other’ Class | Method | Precision (in %) | Recall (in %) | F1-Score (in %) |
---|
500 | 3D CNN and 1D CNN | 70.62 | 89.32 | 77.26 |
500 | 3D ResNet and 1D CNN | 76.47 | 87.21 | 80.98 |
500 | 3D VGG and 1D CNN | 71.71 | 83.61 | 76.33 |
1000 | 3D CNN and 1D CNN | 90.99 | 94.24 | 92.54 |
1000 | 3D ResNet and 1D CNN | 89.08 | 96.91 | 92.57 |
1000 | 3D VGG and 1D CNN | 89.82 | 95.16 | 92.25 |
1500 | 3D CNN and 1D CNN | 91.65 | 95.46 | 93.46 |
1500 | 3D ResNet and 1D CNN | 86.63 | 95.3 | 90.34 |
1500 | 3D VGG and 1D CNN | 88.79 | 96.35 | 92.05 |
2500 | 3D CNN and 1D CNN | 87.82 | 94.7 | 90.97 |
2500 | 3D ResNet and 1D CNN | 88.86 | 96.7 | 92.38 |
2500 | 3D VGG and 1D CNN | 92.56 | 95.76 | 94.09 |
3500 | 3D CNN and 1D CNN | 91.74 | 93.75 | 92.72 |
3500 | 3D ResNet and 1D CNN | 93.6 | 95.47 | 94.35 |
3500 | 3D VGG and 1D CNN | 92.48 | 95.36 | 93.83 |
4500 | 3D CNN and 1D CNN | 92.34 | 92.56 | 92.38 |
4500 | 3D ResNet and 1D CNN | 91.54 | 95.45 | 93.37 |
4500 | 3D VGG and 1D CNN | 91.42 | 92.95 | 92.12 |
5432 (No Sampling) | 3D CNN and 1D CNN | 93.65 | 93.29 | 93.4 |
5432 (No Sampling) | 3D ResNet and 1D CNN | 91.05 | 94.83 | 92.76 |
5432 (No Sampling) | 3D VGG and 1D CNN | 94.66 | 94.39 | 94.45 |
Table 6.
Model performances with 3D VGG nested ResNet and 3D VGG with Leaky ReLU activation for the Prostate cancer patients while varying the majority class samples.
Total Samples from ‘Other’ Class | Method | Precision (in %) | Recall (in %) | F1-Score (in %) |
---|
500 | 3D VGG with nested ResNet and 1D CNN | 86.75 | 96.37 | 90.62 |
500 | 3D VGG with LeakyReLU and 1D CNN | 85.57 | 96.28 | 89.74 |
1000 | 3D VGG with nested ResNet and 1D CNN | 87.37 | 95.49 | 90.92 |
1000 | 3D VGG with LeakyReLU and 1D CNN | 83.56 | 97.29 | 88.55 |
1500 | 3D VGG with nested ResNet and 1D CNN | 89.67 | 96.27 | 92.64 |
1500 | 3D VGG with LeakyReLU and 1D CNN | 91.66 | 95.4 | 93.44 |
2500 | 3D VGG with nested ResNet and 1D CNN | 90.8 | 93.38 | 92.02 |
2500 | 3D VGG with LeakyReLU and 1D CNN | 87.92 | 96.26 | 91.5 |
3500 | 3D VGG with nested ResNet and 1D CNN | 90.57 4 | 95.6 | 92.89 |
3500 | 3D VGG with LeakyReLU and 1D CNN | 88.56 | 94.75 | 91.44 |
4500 | 3D VGG with nested ResNet and 1D CNN | 90.97 | 93.33 | 92.11 |
4500 | 3D VGG with LeakyReLU and 1D CNN | 92.69 | 92.35 | 92.51 |
5432 (No Sampling) | 3D VGG with nested ResNet and 1D CNN | 92.19 | 94.71 | 93.36 |
5432 (No Sampling) | 3D VGG with LeakyReLU and 1D CNN | 91.95 | 94.29 | 93.04 |
Table 7.
Class-wise performances of the top three Models for the Prostate cancer patients.
Class | VGG (with 5432 Majority Class Samples) | ResNet (3500 Majority Class Samples) | VGG (2500 Majority Class Samples) |
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Precision (in %) | Recall (in %) | F1-Score (in %) | Precision (in %) | Recall (in %) | F1-Score (in %) | Precision (in %) | Recall (in %) | F1-Score (in %) |
---|
Bladder | 98.1 | 100 | 99.04 | 99.04 | 100 | 99.52 | 98.1 | 100 | 99.04 |
Rectum | 97.17 | 100 | 98.56 | 97.17 | 100 | 98.56 | 97.17 | 100 | 98.56 |
PTV (Target) | 89.0 | 85.58 | 87.25 | 75.59 | 92.31 | 83.12 | 82.35 | 94.23 | 87.89 |
Femur_L | 97.09 | 99.01 | 98.04 | 95.28 | 100 | 97.58 | 95.28 | 100 | 97.58 |
Femur_R | 96.26 | 100 | 98.1 | 93.58 | 99.03 | 96.23 | 94.44 | 99.03 | 96.68 |
Small Bowel | 92.0 | 79.31 | 85.19 | 96.0 | 82.76 | 88.89 | 82.76 | 82.76 | 82.76 |
Large Bowel | 89.58 | 93.48 | 91.49 | 93.48 | 93.48 | 93.48 | 91.49 | 93.48 | 92.47 |
‘Other’ | 98.11 | 97.75 | 97.93 | 98.69 | 96.17 | 97.41 | 98.92 | 96.62 | 97.76 |
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