A multi-modal vision-language pipeline strategy for contour quality assurance and adaptive optimization

Objective. Accurate delineation of organs-at-risk (OARs) is a critical step in radiotherapy. The deep learning generated segmentations usually need to be reviewed and corrected by oncologists manually, which is time-consuming and operator-dependent. Therefore, an automated quality assurance (QA) and adaptive optimization correction strategy was proposed to identify and optimize 'incorrect' auto-segmentations. Approach. A total of 586 CT images and labels from nine institutions were used. The OARs included the brainstem, parotid, and mandible. The deep learning generated contours were compared with the manual ground truth delineations. In this study, we proposed a novel contour quality assurance and adaptive optimization (CQA-AO) strategy, which consists of the following three main components: (1) the contour QA module classified the deep learning generated contours as either accepted or unaccepted; (2) the unacceptable contour categories analysis module provided the potential error reasons (five unacceptable category) and locations (attention heatmaps); (3) the adaptive correction of unacceptable contours module integrate vision-language representations and utilize convex optimization algorithms to achieve adaptive correction of 'incorrect' contours. Main results. In the contour QA tasks, the sensitivity (accuracy, precision) of CQA-AO strategy reached 0.940 (0.945, 0.948), 0.962 (0.937, 0.913), and 0.967 (0.962, 0.957) for brainstem, parotid and mandible, respectively. The unacceptable contour category analysis, the (FI,AccI,Fmicro,Fmacro) of CQA-AO strategy reached (0.901, 0.763, 0.862, 0.822), (0.855, 0.737, 0.837, 0.784), and (0.907, 0.762, 0.858, 0.821) for brainstem, parotid and mandible, respectively. After adaptive optimization correction, the DSC values of brainstem, parotid and mandible have been improved by 9.4%, 25.9%, and 13.5%, and Hausdorff distance values decreased by 62%, 70.6%, and 81.6%, respectively. Significance. The proposed CQA-AO strategy, which combines QA of contour and adaptive optimization correction for OARs contouring, demonstrated superior performance compare to conventional methods. This method can be implemented in the clinical contouring procedures and improve the efficiency of delineating and reviewing workflow.