Cited by 110Artificial Intelligence in Healthcare and EducationAdvanced Radiotherapy TechniquesRadiomics and Machine Learning in Medical Imaging

A joint ESTRO and AAPM guideline for development, clinical validation and reporting of artificial intelligence models in radiation therapy

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Hurkmans, Coen, Bibault, Jean-Emmanuel, Brock, Kristy K., van Elmpt, Wouter, Feng, Mary, David Fuller, Clifton, Jereczek-Fossa, Barbara A., Korreman, Stine +10 more·2024·Radiotherapy and Oncology

Abstract

BACKGROUND AND PURPOSE: Artificial Intelligence (AI) models in radiation therapy are being developed with increasing pace. Despite this, the radiation therapy community has not widely adopted these models in clinical practice. A cohesive guideline on how to develop, report and clinically validate AI algorithms might help bridge this gap. METHODS AND MATERIALS: A Delphi process with all co-authors was followed to determine which topics should be addressed in this comprehensive guideline. Separate sections of the guideline, including Statements, were written by subgroups of the authors and discussed with the whole group at several meetings. Statements were formulated and scored as highly recommended or recommended. RESULTS: The following topics were found most relevant: Decision making, image analysis, volume segmentation, treatment planning, patient specific quality assurance of treatment delivery, adaptive treatment, outcome prediction, training, validation and testing of AI model parameters, model availability for others to verify, model quality assurance/updates and upgrades, ethics. Key references were given together with an outlook on current hurdles and possibilities to overcome these. 19 Statements were formulated. CONCLUSION: A cohesive guideline has been written which addresses main topics regarding AI in radiation therapy. It will help to guide development, as well as transparent and consistent reporting and validation of new AI tools and facilitate adoption.

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Crossref · 10.1016/j.radonc.2024.110345

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  • Current acceptance testing of AI auto contouring algorithms relies on area- and distance-based metrics that measure overall contour agreement but say nothing about where the model is uncertain.

    “Acceptance testing of AI auto contouring algorithms typically involves both area‐based metrics (e.g., Dice Similarity Coefficient, Intersection over Union (IoU)) and distance‐based metrics (e.g., Hausdorff Distance) evaluated against reference standard contours. 11 , 12 , 13 , 14 These metrics are well established for assessing contour agreement, but they say nothing about where the model is confi”

    From Uncertainty quantification of U‐Net based segmentation tool using conformal prediction (2026) · cites this paper as [11]

    In the Results section on volume segmentation (page unavailable), the guideline recommends reporting Dice Similarity Coefficient and Hausdorff Distance against a ground-truth contour, and says simple geometric validation is insufficient to predict clinical usefulness. It does not state that these metrics reveal nothing about where an auto-contouring model is uncertain; its discussion of model uncertainty concerns dose prediction, not segmentation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 4

  1. [41]41. Holmes, J. ∙ Liu, Z. ∙ Zhang, L. ... Evaluating Large Language Models on a Highly-specialized Topic, Radiation Oncology Physics. Front Oncol. 2023 Jul; 17:1219326 Crossref Scopus (94) Google Scholar
  2. [59]59. Liu, Z, Wang, P, Li, Y, Holmes, J, Shu, P, Zhang, L, Liu, C, Liu, N, Zhu, D, Li, X, Li, Q, Patel, S. H., Sio, T. T, Liu, T, Liu, W. RadOnc-GPT: A Large Language Model for Radiation Oncology. arXiv:2309.10160 webpage visited 6-11-2023. Google Scholar · arXiv
  3. [77]77. Prunaretty, J. ∙ Güngör, G. ∙ Gevaert, T. ... A multi-centric evaluation of self-learning GAN based pseudo-CT generation software for low field pelvic magnetic resonance imaging. Front Oncol. 2023; 13:1245054 Crossref Scopus (7) Google Scholar
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Authors
Hurkmans, C., Bibault, J.-E., Brock, K. K., van Elmpt, W., Feng, M., David Fuller, C., Jereczek-Fossa, B. A., Korreman, S., Landry, G., Madesta, F., Mayo, C., McWilliam, A., Moura, F., Muren, L. P., El Naqa, I., Seuntjens, J., Valentini, V., & Velec, M.
Affiliations
  • Catharina Ziekenhuis (NL)
  • Hôpital Européen Georges-Pompidou (FR)
  • The University of Texas MD Anderson Cancer Center (US)
  • University of California, San Francisco (US)
  • Aarhus University (DK)
  • LMU Klinikum (DE)
  • University Medical Center Hamburg-Eppendorf (DE)
  • University of Michigan (US)
  • University of Manchester (GB)
  • University Health Network (CA)
  • Università Cattolica del Sacro Cuore (IT)
  • University of Toronto (CA)
Corresponding author
Hurkmans, Coen
Venue
Radiotherapy and Oncology
Publisher
Elsevier BV
Published
2024-08
Volume
197
Pages
110345
ISSN
0167-8140 (ISSN-L)
OpenAlex
W4399327635
Cited by
110
References
85
Citations by year
2026: 56 · 2025: 46 · 2024: 7 · 2023: 1
FWCI
10.19
Type
journal article
Language
en
Open access
Locations
  • Radiotherapy and Oncology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TU/e Research Portal (publishedVersion, cc-by)
  • Digital Commons-TMC (Texas Medical Center) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, cc-by)
Funders
European SocieTy for Radiotherapy and Oncology
Topics
  • Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
  • Physical Sciences › Physics and Astronomy › Radiation › Advanced Radiotherapy Techniques
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
Keywords
artificial intelligence, radiotherapy, treatment planning, adaptive radiotherapy, image segmentation, patient-specific quality assurance, outcome prediction, AI ethics, clinical adoption of AI, Delphi consensus
MeSH terms
Algorithms, Artificial Intelligence, Delphi Technique, Humans, Radiotherapy, Radiotherapy Planning, Computer-Assisted, Radiation Oncology

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