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Med. Biol."],"published-print":{"date-parts":[[2025,6,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>\n                  <jats:italic>Objective.<\/jats:italic> To facilitate implementation of plan-of-the-day (POTD) selection for treating locally advanced cervical cancer (LACC), we developed a POTD assessment tool for CBCT-guided radiotherapy (RT). A female pelvis segmentation model (U-Seg3) is combined with a novel quantitative standard operating procedure (qSOP) to identify optimal and acceptable plans. <jats:italic>Approach.<\/jats:italic> The planning CT[i], corresponding structure set[ii], and manually contoured CBCTs[iii] (<jats:italic>n<\/jats:italic> = 226) from 39 LACC patients treated with POTD (<jats:italic>n<\/jats:italic> = 11) or non-adaptive RT (<jats:italic>n<\/jats:italic> = 28) were used to develop U-Seg3, an algorithm incorporating deep-learning and deformable image registration techniques to segment the low-risk clinical target volume (LR-CTV), high-risk CTV (HR-CTV), bladder, rectum, and bowel bag. A single-channel input model (iii only, U-Seg1) was also developed. Contoured CBCTs from the POTD patients were (a) reserved for U-Seg3 validation\/testing, (b) audited to determine optimal and acceptable plans, and (c) used to empirically derive a qSOP that maximised classification accuracy. <jats:italic>Main results.<\/jats:italic> The median (interquartile range) dice similarity coefficient (DSC) between manual and U-Seg3 contours was 0.83 [0.80], 0.78 [0.13], 0.94 [0.05], 0.86 [0.09], and 0.90 [0.05] for the LR-CTV, HR-CTV, bladder, rectum, and bowel. These were significantly higher than U-Seg1 in all structures but bladder. The qSOP classified plans as acceptable if they met target coverage thresholds (LR-CTV <jats:inline-formula>\n                     <jats:tex-math\/>\n                     <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" overflow=\"scroll\">\n                        <mml:mrow>\n                           <mml:mtext>\u2a7e<\/mml:mtext>\n                        <\/mml:mrow>\n                     <\/mml:math>\n                  <\/jats:inline-formula> 99%, HR-CTV <jats:inline-formula>\n                     <jats:tex-math\/>\n                     <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" overflow=\"scroll\">\n                        <mml:mrow>\n                           <mml:mtext>\u2a7e<\/mml:mtext>\n                        <\/mml:mrow>\n                     <\/mml:math>\n                  <\/jats:inline-formula> 99.8%), with lower LR-CTV coverage (<jats:inline-formula>\n                     <jats:tex-math\/>\n                     <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" overflow=\"scroll\">\n                        <mml:mrow>\n                           <mml:mtext>\u2a7e<\/mml:mtext>\n                        <\/mml:mrow>\n                     <\/mml:math>\n                  <\/jats:inline-formula>95%) sometimes allowed. The acceptable plan minimizing bowel irradiation was considered optimal unless substantial bladder sparing could be achieved. With U-Seg3 embedded in the qSOP, optimal and acceptable plans were identified in 46\/60 and 57\/60 cases. <jats:italic>Significance.<\/jats:italic> U-Seg3 outperforms U-Seg1 and all known CBCT-based segmentation models of the female pelvis both in terms of scope and accuracy (median DSC improvement ranging from 0.03\u20130.06). The tool combining U-Seg3 and the qSOP identifies optimal plans with equivalent accuracy as two observers. In an implementation strategy whereby this tool serves as the second observer, plan selection confidence and decision-making time could be improved whilst simultaneously reducing the required number of POTD-trained radiographers by 50%.<\/jats:p>","DOI":"10.1088\/1361-6560\/ade197","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T22:53:32Z","timestamp":1749164012000},"page":"125020","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative and automatic plan-of-the-day assessment to facilitate adaptive radiotherapy in cervical cancer"],"prefix":"10.1088","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0434-8034","authenticated-orcid":true,"given":"Sarah A","family":"Mason","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie E","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1147-3618","authenticated-orcid":true,"given":"Susan","family":"Lalondrelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helen","family":"McNair","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8297-0382","authenticated-orcid":true,"given":"Emma J","family":"Harris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"266","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"pmbade197bib1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.tipsro.2019.10.007","article-title":"RTT-led IGRT for cervix cancer; training, implementation and validation","volume":"12","author":"Alexander","year":"2019","journal-title":"Tech. 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