Clinical Assessment of Deep Learning-Based Uncertainty Maps in Lung Cancer Segmentation

Abstract: Prior to radiation therapy planning, tumours and organs at risk need to be delineated. In recent years, deep learning models have opened the possibility of automating the contouring process, speeding up the procedures and helping clinicians. However, deep learning models, trained using ground truth labels from different clinicians, inevitably incorporate the human-based inter-observer variability as well as other machine-based uncertainties and biases. Consequently, this affects the accuracy of segmentation, representing the primary source of error in contouring tasks. Therefore, clinicians still need to check and manually correct the segmentation and still do not have a measure of reliability. To tackle these issues, researchers have shifted their focus to the topic of probabilistic neural networks and uncertainties in deep learning models. Hence, the main research question of the project is whether a 3D U-Net neural network trained on CT lung cancer images can enhance clinical contouring practice by implementing a probabilistic auto-contouring system. The Monte Carlo dropout technique was employed to generate probabilistic and uncertainty maps. The model calibration was assessed using reliability diagrams, and subsequently, a clinical experiment with a radiation oncologist was conducted. To assess the clinical validity of the uncertainty maps two novel metrics were identified, namely mean uncertainty (MU) and relative uncertainty volume (RUV). The results of this study demonstrated that probability and uncertainty mapping effectively identify cases of under or over-contouring. Although the reliability analysis indicated that the model tends to be overconfident, the outcomes from the clinical experiment showed a strong correlation between the model results and the clinician’s opinion. The two metrics exhibited promising potential as indicators for clinicians to determine whether correction of the predictions is necessary. Hence, probabilistic models revealed to be valuable in clinical practice, supporting clinicians in their contouring and potentially reducing clinical errors.