Evaluating deep learning-based image segmentation for radiotherapy planning in pelvic and abdominal cancers

Introduction: The integration of artificial intelligence (AI) into radiotherapy planning for pelvic and abdominal malignancies has ushered in a new era of precision oncology, enhancing treatment accuracy and patient outcomes. Central to this advancement is the development of sophisticated image segmentation techniques that accurately delineate tumors and surrounding organs at risk. Traditional segmentation methods, often reliant on manual contouring or basic algorithmic approaches, are time-consuming and susceptible to inter-operator variability, potentially compromising treatment efficacy. Moreover, existing deep learning models, while promising, frequently struggle with challenges such as ambiguous anatomical boundaries, small or disconnected lesion regions, and underrepresented classes within training datasets. Methods: To address these challenges, research has progressively evolved from rigid anatomical modeling to more flexible, learning-based paradigms capable of adapting to diverse clinical presentations. However, even with the advent of advanced deep neural networks like U-Net and its variants, segmentation models often face difficulties in generalizing across multi-center datasets due to variability in imaging protocols and anatomical diversity. Furthermore, high computational demands and a lack of interpretability continue to hinder seamless clinical integration. Results and discussion: In this study, we propose an attention-enhanced domain-adaptive segmentation framework tailored for radiotherapy planning in complex anatomical regions. By incorporating a context-aware attention mechanism and a fine-tuned adaptation module, our method aims to achieve high segmentation accuracy while maintaining computational efficiency. This framework not only improves performance on heterogeneous data but also facilitates robust and reproducible contouring of organs and lesions, contributing to more effective and individualized radiation therapy planning.