The Use of Artificial Intelligence Generated Contours in Radiation Planning of the Prostate Brachytherapy

This is a Phase II prospective study evaluating the standard U-net, a deep learning AI algorithm for auto-contouring of the prostate during HDR prostate brachytherapy with the needles in place by new learners. Contouring will be done on TRUS. The study will be conducted with a randomized design. Each patient will be assigned to a new learner and then randomized to manual versus AI-assisted contouring. The randomization will be stratified by new learner type: resident versus fellow/new attending. The hypothesis is that AI-assisted learner contours will have improved Dice coefficients with respect to clinically approved contours compared with manual learner contours. All brachytherapy contours will undergo review by the treating radiation oncologist who is the experienced clinician for clinical approval prior to patient treatment. The experienced clinician will be blinded to the randomization.

• Artificial-intelligence (AI) (Other): Utilizing the addition of artificial intelligence during prostate contouring.

Primary outcomes

• Clinically approved contour vs. Manual and AI assisted contours [1 day]: Dice coefficient \[0: no match, 1: complete match\] between the final clinically approved brachytherapy prostate contours versus the manual and AI-assisted contours provided by the new learner.

Secondary outcomes

• Contouring time [1 day]: Contouring time-to-completion needed to generate and edit manual vs AI-assisted contours for a new learner.
• Impression of AI or manual contours by new learner [1 day]: Subjective impressions/perception of AI or manual contours by the new learner based on survey responses.
• Impression of AI or manual contours by experienced clinician [1 day]: Subjective impressions/perception of AI or manual contours by the experienced clinician based on survey responses.
• Clinician contours vs. Trus images with and without needles [1 day]: Dice coefficients of expert clinician contours between TRUS images with implanted needles and TRUS images after removal of bottom needle rows.

Sex: Male, ages: 18 Years to any

Inclusion Criteria:

* 18 years of age and older
* Deemed suitable candidates for whole gland HDR prostate brachytherapy under general anesthesia as a monotherapy, boost or salvage treatment.

Exclusion Criteria:

* Prior permanent seed LDR brachytherapy implant
* Prior transurethral resection of the prostate (TURP)
* Presence or insertion of a rectal spacer
* Focal HDR brachytherapy treatment i.e. not whole prostate

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• Study Protocol (PDF, 2025-04-21)

• Martin King, MD, PHD, Principal investigator, Dana-Farber Cancer Institute / Brigham Women's Hospital