International Journal of Innovative Science and Research Technology

Volume x , Issue y , Month - 2016

Automatic Contouring Analysis of Lung Cancer for

Radiotherapy Radiation Planning from Ct-Simulator
Image
¹Putri Pradita Nuramalia; ²Suryono; ³Edy Susanto
¹Applied Masters Students in Health Diagnostic Imaging Poltekkes Ministry of Health Semarang
²Diponegoro University Semarang Information Systems Postgraduate Program
³Department of Radiodiagnostic Engineering and Radiotherapy Polytechnic of the Ministry of Health Semarang
Semarang, Indonesia
Corresponding author: putri.pradita15@gmail.com

Abstract—Background: Determination of tumor and I. INTRODUCTION

radiotherapy target volume is very important to avoid
local and regional failure in lung cancer. Radiotherapy
planning always considers critical normal tissue structure
or Organ at Risk (OAR). Manual contouring is considered
the gold standard in radiotherapy planning, but the results
of the contours are still found to intra- and inter-observer
variation. A digital image processing system that can
determine tumor targets and OAR automatically and
semi-automatically with computer programming is
expected to assist the coturing process. Objective: To
create a digital contouring computer program to assist in
planning radiotherapy irradiation of lung cancer cases
with CT-Simulator image guidance. Methods:
Experimental research by contouring CT-Simulator
images of lung cancer cases using automatic segmentation,
semi-automatic segmentation, and a combination of
automatic, semi-automatic, and manual segmentation.
Then, the contour accuracy is assessed by a radiation
oncologist. Results: Results showed that contouring with
automatic segmentation had high accuracy on lungs (>95),
moderate on tumor targets (72.22) and heart (73.33), and
low accuracy on esophagus (34.44) and spinal cord (36,67).
Semi-automatic segmentation have high accuracy on
esophagus (96.67) and spinal cord (95.56), moderate on
tumor targets (73.33), heart (66.67), right lung (66, 25) and
left (72.94). The combination of automatic, semi-automatic
and manual segmentation showed high accuracy on tumor
targeting and OAR (>95). Conclusion: Application of
automatic or semi-automatic segmentation with location
and gray level classification methods for lung cancer cases
on program has’t gotten maximum results. Application of
a contouring program that combines automatic, semi-
automatic, and manual segmentation is more effective for
the contouring process in lung cancer because it can
balance of human interaction and automation.
Keywords: Automatic Contouring, Lung Cancer,
Radiotherapy.
Radiotherapy is one of the most effective methods for
cancer treatment, utilization of energy ionizing radiation
(high energy radiation that displaces electrons from
atoms and molecules) in radiotherapy used to destroy
cancer cells and inhibit their growth[1]–[3]. CT-Scan is
indispensable in radiation planning or radiotherapy
treatment planning, to provide high geometric accuracy
in the position of tumors and surrounding tissues and
organs at risk for accurate identification and to provide
electron density information maps for various tissues to
be used for dose calculation in treatment planning
system (TPS) [4]. Local irradiation, such as
radiotherapy, is highly dependent on the accuracy of the
imaging procedure by the defined target tissue. This is
the basis for successful irradiation with minimal
complications[5].
Until recently contour segmentation was largely a
manual task by radiation oncologists and radiation
technology was considered the gold standard. Contours
can be time-consuming and published data show a high
degree of inter-observer variability[6], [7]. Automated or
semi-automated contouring tools are increasingly being
used in tumor formation tasks for radiotherapy.
Although fully automatic contouring tools have’t yet
achieved sufficient efficiency, semi-automatic
contouring tools are more effective because can balance
human interaction and automation[1].
II. METHODOLOGY
A. Pastient Data
The patient data used in this study were CT-Simulator
lung images from lung cancer patients in DICOM format.
Target volume and risk organ volume (OAR) must be
precisely contoured to produce an accurate treatment plan
[8]. The OARs included are the heart, esophagus, spinal
cord, left lung, and right lung[9].

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 International Journal of Innovative Science and Research Technology

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B. Methodology
This research is an experimental study which was
tested qualitatively. The research sample (lung CT-
Table1. Average Contouring Accuracy Score
Simulator images from lung cancer patients) applied
three types of segmentation (automatic segmentation, Otomatis Semi- Combinatio
semi-automatic segmentation and a combination of Otomatis n
automatic, semi-automatic, and manual segmentation). Tumor 72,22 73,33 97,78
The three types of segmentation were compared for their Target
accuracy values rated by radiation oncologists. Radiation Heart 73,33 66,67 93,33
oncologists rated of accuracy on a predetermined scale. Esophagus 34,44 96,67 97,78
After assessing the accuracy of contouring, the data is Spinal Cord 36,67 95,56 97,78
then processed with SPSS. Right Lung 97,5 66,25 98,75
The contouring accuracy data for the three types of Left Lung 98,82 72,94 98,82
segmentation are averaged. In addition, the data was
calculated using a non-parametric test. Kruskal-Wallis Table 2. Kruskal-Wallis Test Results
test followed by Tamhane's post hoc analysis.
Variable p-value
III. RESULT AND DISCUSSION Otomatis
In this study the experiment was conducted using Tumor Target Semi-Otomatis 0,000
MATLAB software on the image to be processed. Combination
Contouring is applying with three types of segmentation Otomatis
(automatic segmentation, semi-automatic segmentation Heart Semi-Otomatis 0,225
and a combination of automatic, semi-automatic, and Combination
manual segmentation). Automatic segmentation using the Otomatis
K-Nearest Neighbor method and thresholding. While the Esophagus Semi-Otomatis 0,000
semi-automatic segmentation uses the active contour Combination
method and the manual method of ROI in manual Otomatis
segmentation. The results of the study are shown in Spinal Cord Semi-Otomatis 0,000
figure 1. Combination
Otomatis
Right Lung Semi-Otomatis 0,000
Combination
Otomatis
Left Lung Semi-Otomatis 0,000
Combination

(a) (b)
Table 3. Mann-Whitney Test Results
Variable p-value
Tumor Target 0,673
Heart 0,700
Otomatis and Esophagus 0,000
Semi-Otomatis Spinal Cord 0,000
Right Lung 0,000
(c) (d) Left Lung 0,000
Figure 1. Original image (a), automatic segmentation (b), Tumor Target 0,001
semi-automatic segmentation (c), combination of Heart 0,400
automatic, semi-automatic and manual segmentation (d). Otomatis and Esophagus 0,000
Combination Spinal Cord 0,000
The contouring results obtained from the segmented Right Lung 0,780
image are then measured for accuracy by radiation Left Lung 1,000
oncologists on the tumor target and OAR which can be Semi-Otomatis Tumor Target 0,000
seen in table 1. While the results of the Kruskal-Wallis and Heart 0,100
test can be seen in table 2 and the results of Tamhane's Combination Esophagus 0,791
post hoc test can be seen in table 3.
Spinal Cord 0,584

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 International Journal of Innovative Science and Research Technology
Right Lung 0,000
Left Lung 0,000
From the results of the average grade of the accuracy
of the automatic segmentation contouring shows a low
grade in the esophagus and spinal cord. The tumor and
heart targets have not received a middle score. High
scores are only found in both right and left lungs.
In semi-automatic segmentation, the esophagus and
spinal cord high score. While the target values for tumor,
heart, right lung, and left lung still get middle scores.
The combination of automatic, semi-automatic, and
manual segmentation is an improvement from the
mistakenness of automatic and semi-automatic
segmentation. This editing can enhanced provides high
value across contoured areas. While fully automated
tools still less efficiency, tools that balance human
interaction and automation can be more effective[1].
In this study, program development using fully
automatic and semi-automatic segmentation is still less
effective because there are several factors such as gray
level with parts that should not be contoured, causing the
program to detect organs that should be contoured.
However, the results of a contouring program that uses a
combination of automatic, semi-automatic, and manual
segmentation are very effective because of the balance
between human interaction and automation. So users can
add and subtract contours based on other considerations,
not only based on the CT-Simulator image. The existence
of a process there makes the contour results accurate
according to the ICRU guidelines.
From the results of the Kruskal-Wallis test were <
0.05 except for the heart, it was concluded that there was
at least a difference between the two groups. The next
test is post hoc using Mann-Whitney to find out between
groups that have differences[10]. The results of the
Mann-Whitney test, it can be ascertained that there is no
difference in the results according to contouring on
variables with p-vaue > 0.001. The variable with p-value
< 0.001 indicates a difference in the two groups.
IV. CONCLUTION
Fully automatic segmentation with location
classification methods and automatic gray level and fully
semi-automatic segmentation with methods that use a
closed curve model that widens or narrows at the same
degree of gray level in the CT-Simulator image of lung
cancer cases has not obtained maximum results. The
combination of automatic, semi-automatic, and manual
segmentation can increase the accuracy of contouring
because of the editing process to improve the contouring
results that are less than automatic or semi-automatic
segmentation in lung cancer. Contouring programs are
more effective because they balance human interaction
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and automation. With the balance between human
interaction and automation, it can minimize time, reduce
inter-observer variability, increase contour accuracy, and
can add or reduce contour areas according to the doctor's
wishes based on various considerations.
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