We establish an open framework for developing plan optimization models for knowledge-based planning (KBP) in radiotherapy. Our framework includes reference plans for 100 patients with head-and-neck cancer and high-quality dose predictions from 19 KBP models that were developed by different research groups during the OpenKBP Grand Challenge. The dose predictions were input to four optimization models to form 76 unique KBP pipelines that generated 7600 plans. The predictions and plans were compared to the reference plans via: dose score, which is the average mean absolute voxel-by-voxel difference in dose a model achieved; the deviation in dose-volume histogram (DVH) criterion; and the frequency of clinical planning criteria satisfaction. We also performed a theoretical investigation to justify our dose mimicking models. The range in rank order correlation of the dose score between predictions and their KBP pipelines was 0.50 to 0.62, which indicates that the quality of the predictions is generally positively correlated with the quality of the plans. Additionally, compared to the input predictions, the KBP-generated plans performed significantly better (P<0.05; one-sided Wilcoxon test) on 18 of 23 DVH criteria. Similarly, each optimization model generated plans that satisfied a higher percentage of criteria than the reference plans. Lastly, our theoretical investigation demonstrated that the dose mimicking models generated plans that are also optimal for a conventional planning model. This was the largest international effort to date for evaluating the combination of KBP prediction and optimization models. In the interest of reproducibility, our data and code is freely available at https://github.com/ababier/open-kbp-opt.
Radiation therapy (RT) is widely employed in the clinic for the treatment of head and neck (HaN) cancers. An essential step of RT planning is the accurate segmentation of various organs-at-risks (OARs) in HaN CT images. Nevertheless, segmenting OARs manually is time-consuming, tedious, and error-prone considering that typical HaN CT images contain tens to hundreds of slices. Automated segmentation algorithms are urgently required. Recently, convolutional neural networks (CNNs) have been extensively investigated on this task. Particularly, 3D CNNs are frequently adopted to process 3D HaN CT images. There are two issues with naïve 3D CNNs. First, the depth resolution of 3D CT images is usually several times lower than the in-plane resolution. Direct employment of 3D CNNs without distinguishing this difference can lead to the extraction of distorted image features and influence the final segmentation performance. Second, a severe class imbalance problem exists, and large organs can be orders of times larger than small organs. It is difficult to simultaneously achieve accurate segmentation for all the organs. To address these issues, we propose a novel hybrid CNN that fuses 2D and 3D convolutions to combat the different spatial resolutions and extract effective edge and semantic features from 3D HaN CT images. To accommodate large and small organs, our final model, named OrganNet2.5D, consists of only two instead of the classic four downsampling operations, and hybrid dilated convolutions are introduced to maintain the respective field. Experiments on the MICCAI 2015 challenge dataset demonstrate that OrganNet2.5D achieves promising performance compared to state-of-the-art methods.