Deep learning based automatic segmentation of the Internal Pudendal Artery in definitive radiotherapy treatment planning of localized prostate cancer

Background and purpose Radiation-induced erectile dysfunction (RiED) commonly affects prostate cancer patients, prompting clinical trials across institutions to explore dose-sparing to internal-pudendal-arteries (IPA) for preserving sexual potency. IPA, challenging to segment, isn't conventionally considered an organ-at-risk (OAR). This study proposes a deep learning (DL) auto-segmentation model for IPA, using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) or CT alone to accommodate varied clinical practices. Materials and methods A total of 86 patients with CT and MRI images and noisy IPA labels were recruited in this study. We split the data into 42/14/30 for model training, testing, and a clinical observer study, respectively. There were three major innovations in this model: 1) we designed an architecture with squeeze-and-excite blocks and modality attention for effective feature extraction and production of accurate segmentation, 2) a novel loss function was used for training the model effectively with noisy labels, and 3) modality dropout strategy was used for making the model capable of segmentation in the absence of MRI. Results Test dataset metrics were DSC 61.71 ± 7.7 %, ASD 2.5 ± .87 mm, and HD95 7.0 ± 2.3 mm. AI segmented contours showed dosimetric similarity to expert physician’s contours. Observer study indicated higher scores for AI contours (mean = 3.7) compared to inexperienced physicians’ contours (mean = 3.1). Inexperienced physicians improved scores to 3.7 when starting with AI contours. Conclusion The proposed model achieved good quality IPA contours to improve uniformity of segmentation and to facilitate introduction of standardized IPA segmentation into clinical trials and practice.