The precision of contouring target structures and organs-at-risk (OAR) in radiotherapy planning is crucial for ensuring treatment efficacy and patient safety. Recent advancements in deep learning (DL) have significantly improved OAR contouring performance, yet the reliability of these models, especially in the presence of out-of-distribution (OOD) scenarios, remains a concern in clinical settings. This application study explores the integration of epistemic uncertainty estimation within the OAR contouring workflow to enable OOD detection in clinically relevant scenarios, using specifically compiled data. Furthermore, we introduce an advanced statistical method for OOD detection to enhance the methodological framework of uncertainty estimation. Our empirical evaluation demonstrates that epistemic uncertainty estimation is effective in identifying instances where model predictions are unreliable and may require an expert review. Notably, our approach achieves an AUC-ROC of 0.95 for OOD detection, with a specificity of 0.95 and a sensitivity of 0.92 for implant cases, underscoring its efficacy. This study addresses significant gaps in the current research landscape, such as the lack of ground truth for uncertainty estimation and limited empirical evaluations. Additionally, it provides a clinically relevant application of epistemic uncertainty estimation in an FDA-approved and widely used clinical solution for OAR segmentation from Varian, a Siemens Healthineers company, highlighting its practical benefits.

本研究解决了放射治疗计划中靶区和风险器官轮廓描绘精度不足的问题，尤其是在分布外（OOD）场景下模型的可靠性。我们提出了一种将认识不确定性估计整合到OAR轮廓描绘工作流中的新方法，通过一种先进的统计方法增强OOD检测能力。实证结果表明，该方法在OOD检测中的AUC-ROC达到0.95，具有良好的临床应用潜力。

将认识不确定性估计整合到放射治疗工作流程中