Artificial Intelligence (AI)-based auto-delineation technologies rapidly delineate multiple structures of interest like organs-at-risk and tumors in 3D medical images, reducing personnel load and facilitating time-critical therapies. Despite its accuracy, the AI may produce flawed delineations, requiring clinician attention. Quality assessment (QA) of these delineations is laborious and demanding. Delineation error detection systems (DEDS) aim to aid QA, yet questions linger about potential challenges to their adoption and time-saving potential. To address these queries, we first conducted a user study with two clinicians from Holland Proton Therapy Center, a Dutch cancer treatment center. Based on the study’s findings about the clinicians’ error detection workflows with and without DEDS assistance, we developed a simulation model of the QA process, which we used to assess different error detection workflows on a retrospective cohort of 42 head and neck cancer patients. Results suggest possible time savings, provided the per-slice analysis time stays close to the current baseline and trading-off delineation quality is acceptable. Our findings encourage the development of user-centric delineation error detection systems and provide a new way to model and evaluate these systems’ potential clinical value.@en

Practical applications of mechanical metamaterials often involve solving inverse problems aimed at finding microarchitectures that give rise to certain properties. The limited resolution of additive manufacturing techniques often requires solving such inverse problems for specific specimen sizes. Moreover, the candidate microarchitectures should be resistant to fatigue and fracture. Such a multi-objective inverse design problem is formidably difficult to solve but its solution is the key to real-world applications of mechanical metamaterials. Here, a modular approach titled “Deep-DRAM” that combines four decoupled models is proposed, including two deep learning (DL) models, a deep generative model based on conditional variational autoencoders, and direct finite element (FE) simulations. Deep-DRAM integrates these models into a framework capable of finding many solutions to the posed multi-objective inverse design problem based on random-network unit cells. Using an extensive set of simulations as well as experiments performed on 3D printed specimens, it is demonstrate that: 1) the predictions of the DL models are in agreement with FE simulations and experimental observations, 2) an enlarged envelope of achievable elastic properties (e.g., rare combinations of double auxeticity and high stiffness) is realized using the proposed approach, and 3) Deep-DRAM can provide many solutions to the considered multi-objective inverse design problem.

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Bayesian Neural Nets (BNN) are increasingly used for robust organ auto-contouring. Uncertainty heatmaps extracted from BNNs have been shown to correspond to inaccurate regions. To help speed up the mandatory quality assessment (QA) of contours in radiotherapy, these heatmaps could be used as stimuli to direct visual attention of clinicians to potential inaccuracies. In practice, this is non-trivial to achieve since many accurate regions also exhibit uncertainty. To influence the output uncertainty of a BNN, we propose a modified accuracy-versus-uncertainty (AvU) metric as an additional objective during model training that penalizes both accurate regions exhibiting uncertainty as well as inaccurate regions exhibiting certainty. For evaluation, we use an uncertainty-ROC curve that can help differentiate between Bayesian models by comparing the probability of uncertainty in inaccurate versus accurate regions. We train and evaluate a FlipOut BNN model on the MICCAI2015 Head and Neck Segmentation challenge dataset and on the DeepMind-TCIA dataset, and observed an increase in the AUC of uncertainty-ROC curves by 5.6% and 5.9%, respectively, when using the AvU objective. The AvU objective primarily reduced false positives regions (uncertain and accurate), drawing less visual attention to these regions, thereby potentially improving the speed of error detection.

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Deep learning models for organ contouring in radiotherapy are poised for clinical usage, but currently, there exist few tools for automated quality assessment (QA) of the predicted contours. Bayesian models and their associated uncertainty, can potentially automate the process of detecting inaccurate predictions. We investigate two Bayesian models for auto-contouring, DropOut and FlipOut, using a quantitative measure – expected calibration error (ECE) and a qualitative measure – region-based accuracy-vs-uncertainty (R-AvU) graphs. It is well understood that a model should have low ECE to be considered trustworthy. However, in a QA context, a model should also have high uncertainty in inaccurate regions and low uncertainty in accurate regions. Such behaviour could direct visual attention of expert users to potentially inaccurate regions, leading to a speed-up in the QA process. Using R-AvU graphs, we qualitatively compare the behaviour of different models in accurate and inaccurate regions. Experiments are conducted on the MICCAI2015 Head and Neck Segmentation Challenge and on the DeepMindTCIA CT dataset using three models: DropOut-DICE, Dropout-CE (Cross Entropy) and FlipOut-CE. Quantitative results show that DropOut-DICE has the highest ECE, while Dropout-CE and FlipOut-CE have the lowest ECE. To better understand the difference between DropOut-CE and FlipOut-CE, we use the R-AvU graph which shows that FlipOut-CE has better uncertainty coverage in inaccurate regions than DropOut-CE. Such a combination of quantitative and qualitative metrics explores a new approach that helps to select which model can be deployed as a QA tool in clinical settings.
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