Hierarchical clustering applied to automatic atlas based segmentation of 25 cardiac sub-structures

Purpose: Segmentation of cardiac sub-structures for dosimetric analyses is usually performed manually in timeconsuming procedure. Automatic segmentation may facilitate large-scale retrospective analysis and adaptive radiotherapy. Various approaches, among them Hierarchical Clustering, were applied to improve performance of atlas-based segmentation (ABS). Methods: Training dataset of ABS consisted of 36 manually contoured CT-scans. Twenty-five cardiac substructures were contoured as regions of interest (ROIs). Five auto-segmentation methods were compared: simultaneous automatic contouring of all 25 ROIs (Method-1); automatic contouring of all 25 ROIs using lungs as anatomical barriers (Method-2); automatic contouring of a single ROI for each contouring cycle (Method-3); hierarchical cluster-based automatic contouring (Method-4); simultaneous truth and performance level estimation (STAPLE). Results were evaluated on 10 patients. Dice similarity coefficient (DSC), average Hausdorff distance (AHD), volume comparison and physician score were used as validation metrics. Results: Atlas performance improved increasing number of atlases. Among the five ABS methods, Hierarchical Clustering workflow showed a significant improvement maintaining a clinically acceptable time for contouring. Physician scoring was acceptable for 70% of the ROI automatically contoured. Inter-observer evaluation showed that contours obtained by Hierarchical Clustering method are statistically comparable with them obtained by a second, independent, expert contourer considering DSC. Considering AHD, distance from the gold standard is lower for ROIs segmented by ABS. Conclusions: Hierarchical clustering resulted in best ABS results for the primarily investigated platforms and compared favorably to a second benchmark system. Auto-contouring of smaller structures, being in range of variation between manual contourers, may be ideal for large-scale retrospective dosimetric analysis.