Qualitative Evaluation of Common Quantitative Metrics for Clinical Acceptance of Automatic Segmentation: a Case Study on Heart Contouring from CT Images by Deep Learning Algorithms

L. B. van den Oever, W. A. van Veldhuizen, L. J. Cornelissen, D. S. Spoor, T. P. Willems, G. Kramer, T. Stigter, M. Rook, A. P. G. Crijns, M. Oudkerk, R. N. J. Veldhuis, G. H. de Bock, P. M. A. van Ooijen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Organs-at-risk contouring is time consuming and labour intensive. Automation by deep learning algorithms would decrease the workload of radiotherapists and technicians considerably. However, the variety of metrics used for the evaluation of deep learning algorithms make the results of many papers difficult to interpret and compare. In this paper, a qualitative evaluation is done on five established metrics to assess whether their values correlate with clinical usability. A total of 377 CT volumes with heart delineations were randomly selected for training and evaluation. A deep learning algorithm was used to predict the contours of the heart. A total of 101 CT slices from the validation set with the predicted contours were shown to three experienced radiologists. They examined each slice independently whether they would accept or adjust the prediction and if there were (small) mistakes. For each slice, the scores of this qualitative evaluation were then compared with the Sorensen-Dice coefficient (DC), the Hausdorff distance (HD), pixel-wise accuracy, sensitivity and precision. The statistical analysis of the qualitative evaluation and metrics showed a significant correlation. Of the slices with a DC over 0.96 (N = 20) or a 95% HD under 5 voxels (N = 25), no slices were rejected by the readers. Contours with lower DC or higher HD were seen in both rejected and accepted contours. Qualitative evaluation shows that it is difficult to use common quantification metrics as indicator for use in clinic. We might need to change the reporting of quantitative metrics to better reflect clinical acceptance.

Original languageEnglish
Pages (from-to)240-247
Number of pages8
Issue number2
Early online date26-Jan-2022
Publication statusPublished - Apr-2022


  • Automatic contouring
  • Deep learning
  • CT
  • Qualitative assessment
  • Turing test

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