Slice-by-slice deep learning aided oropharyngeal cancer segmentation with adaptive thresholding for spatial uncertainty on FDG PET and CT images

Tumor segmentation is a fundamental step for radiotherapy treatment planning. To define an accurate segmentation of the primary tumor (GTVp) of oropharyngeal cancer patients (OPC), simultaneous assessment of different image modalities is needed, and each image volume is explored slice-by-slice from different orientations. Moreover, the manual fixed boundary of segmentation neglects the spatial uncertainty known to occur in tumor delineation. This study proposes a novel automatic deep learning (DL) model to assist radiation oncologists in a slice-by-slice adaptive GTVp segmentation on registered FDG PET/CT images. We included 138 OPC patients treated with (chemo)radiation in our institute. Our DL framework exploits both inter and intra-slice context. Sequences of 3 consecutive 2D slices of concatenated FDG PET/CT images and GTVp contours were used as input. A 3-fold cross validation was performed three times, training on sequences extracted from the Axial (A), Sagittal (S), and Coronal (C) plane of 113 patients. Since consecutive sequences in a volume contain overlapping slices, each slice resulted in three outcome predictions that were averaged. In the A, S, and C planes, the output shows areas with different probabilities of predicting the tumor. The performance of the models was assessed on 25 patients at different probability thresholds using the mean Dice Score Coefficient (DSC). Predictions were the closest to the ground truth at a probability threshold of 0.9 (DSC of 0.70 in the A, 0.77 in the S, and 0.80 in the C plane). The promising results of the proposed DL model show that the probability maps on registered FDG PET/CT images could guide radiation oncologists in a slice-by-slice adaptive GTVp segmentation.