Potential of E-Learning Interventions and Artificial Intelligence–Assisted Contouring Skills in Radiotherapy: The ELAISA Study
Rasmussen M.E. Akbarov K. Titovich E. Nijkamp J.A. Van Elmpt W. Primdahl H. Lassen P. Cacicedo J. Cordero-Mendez L. Uddin A.F.M.K. Mohamed A. Prajogi B. Brohet K.E. Nyongesa C. Lomidze D. Prasiko G. Ferraris G. Mahmood H. Stojkovski I. Isayev I. Mohamad I. Shirley L. Kochbati L. Eftodiev L. Piatkevich M. Jara M.M.B. Spahiu O. Aralbayev R. Zakirova R. Subramaniam S. Kibudde S. Tsegmed U. Korreman S.S. Eriksen J.G.
1 September 2024Lippincott Williams and Wilkins
JCO Global Oncology
2024#10
PURPOSE Most research on artificial intelligence–based auto-contouring as template (AI-assisted contouring) for organs-at-risk (OARs) stem from high-income countries. The effect and safety are, however, likely to depend on local factors. This study aimed to investigate the effects of AI-assisted contouring and teaching on contouring time and contour quality among radiation oncologists (ROs) working in low- and middle-income countries (LMICs). MATERIALS Ninety-seven ROs were randomly assigned to either manual or AI-assisted AND METHODS contouring of eight OARs for two head-and-neck cancer cases with an in-between teaching session on contouring guidelines. Thereby, the effect of teaching (yes/no) and AI-assisted contouring (yes/no) was quantified. Second, ROs completed short-term and long-term follow-up cases all using AI assistance. Contour quality was quantified with Dice Similarity Coefficient (DSC) between ROs’ contours and expert consensus contours. Groups were compared using absolute differences in medians with 95% CIs. RESULTS AI-assisted contouring without previous teaching increased absolute DSC for optic nerve (by 0.05 [0.01; 0.10]), oral cavity (0.10 [0.06; 0.13]), parotid (0.07 [0.05; 0.12]), spinal cord (0.04 [0.01; 0.06]), and mandible (0.02 [0.01; 0.03]). Contouring time decreased for brain stem (–1.41 [–2.44; –0.25]), mandible (–6.60 [–8.09; –3.35]), optic nerve (–0.19 [–0.47; –0.02]), parotid (–1.80 [–2.66; –0.32]), and thyroid (–1.03 [–2.18; –0.05]). Without AI-assisted contouring, teaching increased DSC for oral cavity (0.05 [0.01; 0.09]) and thyroid (0.04 [0.02; 0.07]), and contouring time increased for mandible (2.36 [–0.51; 5.14]), oral cavity (1.42 [–0.08; 4.14]), and thyroid (1.60 [–0.04; 2.22]). CONCLUSION The study suggested that AI-assisted contouring is safe and beneficial to ROs working in LMICs. Prospective clinical trials on AI-assisted contouring should, however, be conducted upon clinical implementation to confirm the effects.
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Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
International Atomic Energy Agency, Vienna, Austria
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
MAASTRO Clinic, Maastricht University Medical Centre, Maastricht, Netherlands
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Department of Radiation Oncology, Cruces University Hospital, Bilbao, Spain
Labaid Cancer Hospital, Super Speciality Centre, Dhaka, Bangladesh
National Cancer Institute, University of Gezira, Wad Madani, Sudan
Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Dharmais Cancer Hospital, Jakarta, Indonesia
Kenyatta National Hospital, Nairobi, Kenya
Tbilisi State Medical University, Ingorokva High Medical Technology University Clinic, Tbilisi, Georgia
Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
Centro de Radioterapiya dean Funes, Cordoba, Argentina
Atomic Energy Cancer Hospital NORI, Islamabad, Pakistan
University Clinic of Radiotherapy and Oncology, Skopje, North Macedonia
National Center of Oncology, Baku, Azerbaijan
King Hussein Cancer Center, Amman, Jordan
Christian Institute of Health Science and Research, Dimapur, India
Hospital Abderrahmen Mami, Ariana, Tunisia
Moldavian Oncology Institute, Chisinau, Moldova
N. N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
Hospital México, San José, Costa Rica
Mother Tereza Hospital, Tirana, Albania
National Centre of Oncology and Hematology, Bishkek, Kyrgyzstan
Center of Nuclear Medicine and Oncology, Semey, Kazakhstan
Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
Uganda Cancer Institute, Kampala, Uganda
National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
Experimental Clinical Oncology
International Atomic Energy Agency
Department of Clinical Medicine
MAASTRO Clinic
Department of Oncology
Department of Radiation Oncology
Labaid Cancer Hospital
National Cancer Institute
Cipto Mangunkusumo Hospital
Dharmais Cancer Hospital
Kenyatta National Hospital
Tbilisi State Medical University
Nepal Cancer Hospital and Research Center
Centro de Radioterapiya dean Funes
Atomic Energy Cancer Hospital NORI
University Clinic of Radiotherapy and Oncology
National Center of Oncology
King Hussein Cancer Center
Christian Institute of Health Science and Research
Hospital Abderrahmen Mami
Moldavian Oncology Institute
N. N. Alexandrov National Cancer Centre of Belarus
Hospital México
Mother Tereza Hospital
National Centre of Oncology and Hematology
Center of Nuclear Medicine and Oncology
Hospital Kuala Lumpur
Uganda Cancer Institute
National Cancer Center of Mongolia
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