# Comprehensive and Clinically Accurate Head and Neck Organs at Risk Delineation via Stratified Deep Learning: A Large-scale Multi-Institutional Study

arXiv: https://arxiv.org/abs/2111.01544 · HTML: https://mlsanity.com/paper/2111.01544/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 8 of its 34 references that are in the map.
- First posted on arXiv 1 Nov 2021.

## Builds on (most cited first, 8 of 8)

- [DARTS: Differentiable Architecture Search](https://mlsanity.com/paper/1806.09055/) (2018)
- [Instance Normalization: The Missing Ingredient for Fast Stylization](https://mlsanity.com/paper/1607.08022/) (2016)
- [Convolutional Pose Machines](https://mlsanity.com/paper/1602.00134/) (2016)
- [Auto-DeepLab: Hierarchical Neural Architecture Search for Semantic Image Segmentation](https://mlsanity.com/paper/1901.02985/) (2019)
- [Deep learning to achieve clinically applicable segmentation of head and neck anatomy for radiotherapy](https://mlsanity.com/paper/1809.04430/) (2018)
- [AnatomyNet: Deep Learning for Fast and Fully Automated Whole-volume Segmentation of Head and Neck Anatomy](https://mlsanity.com/paper/1808.05238/) (2018)
- [Less is More: Simultaneous View Classification and Landmark Detection for Abdominal Ultrasound Images](https://mlsanity.com/paper/1805.10376/) (2018)
- [Multi-institutional Validation of Two-Streamed Deep Learning Method for Automated Delineation of Esophageal Gross Tumor Volume using planning-CT and FDG-PETCT](https://mlsanity.com/paper/2110.05280/) (2021)

## Built on by (most cited first, 1 of 1)

- [SAME++: A Self-supervised Anatomical eMbeddings Enhanced medical image registration framework using stable sampling and regularized transformation](https://mlsanity.com/paper/2311.14986/) (2023)

## Abstract (arXiv)

Accurate organ at risk (OAR) segmentation is critical to reduce the radiotherapy post-treatment complications. Consensus guidelines recommend a set of more than 40 OARs in the head and neck (H&N) region, however, due to the predictable prohibitive labor-cost of this task, most institutions choose a substantially simplified protocol by delineating a smaller subset of OARs and neglecting the dose distributions associated with other OARs. In this work we propose a novel, automated and highly effective stratified OAR segmentation (SOARS) system using deep learning to precisely delineate a comprehensive set of 42 H&N OARs. SOARS stratifies 42 OARs into anchor, mid-level, and small & hard subcategories, with specifically derived neural network architectures for each category by neural architecture search (NAS) principles. We built SOARS models using 176 training patients in an internal institution and independently evaluated on 1327 external patients across six different institutions. It consistently outperformed other state-of-the-art methods by at least 3-5% in Dice score for each institutional evaluation (up to 36% relative error reduction in other metrics). More importantly, extensive multi-user studies evidently demonstrated that 98% of the SOARS predictions need only very minor or no revisions for direct clinical acceptance (saving 90% radiation oncologists workload), and their segmentation and dosimetric accuracy are within or smaller than the inter-user variation. These findings confirmed the strong clinical applicability of SOARS for the OAR delineation process in H&N cancer radiotherapy workflows, with improved efficiency, comprehensiveness, and quality.