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          How Can Artificial Intelligence Support Head and Neck Cancer Treatment

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          Radiation oncologists reviewing and discussing a clinical case during a contouring workshop. (Photo: E. Harsdorf/IAEA)

          The IAEA has launched a new two-year coordinated research project to explore how artificial intelligence can assist with contouring — a crucial step in cancer treatment, in which a tumour and the surrounding tissues are outlined to guide the delivery of radiation therapy. The project will delve into the challenges and limitations of implementing artificial intelligence-based tools within radiotherapy.

          Despite major advances in radiation oncology in recent decades — from innovations in treatment equipment to advances in imaging modalities — there are still considerable variations in contouring practices. The specifications for these practices for gross tumour volume (the extent of a tumour that can be discerned through imaging techniques), clinical target volume (the tumour and surrounding tissues that may contain cancer cells) and organs-at-risk (nearby healthy tissues and organs) have evolved over time as international groups developed guidelines for the radiation oncology community.

          “Missteps during contouring can significantly impact treatment outcomes — be it from missing the tumours or irradiating normal tissues unnecessarily,” noted Tomoaki Tamaki, Head of Applied Radiation Biology and Radiotherapy in the IAEA Division of Human Health. “Limitations in diagnostic imaging, difficulties in identifying the tumour accurately, and the increasing global cancer burden can all add to the contouring challenges clinicians face.”

          Artificial intelligence (AI) tools such as deep learning-based algorithms can be valuable as previous studies have shown a reduction in contouring time and variation. Furthermore, explainable AI (XAI) can help by enabling cancer care providers to understand the contouring decisions and predictions made by AI models.

          This new coordinated research project (CRP) builds on a previous project, which concluded in 2024 and focused on the usefulness of AI tools in identifying organs-at-risk — a task which involves the recognition of normal anatomical structures and adjustments for any individual variations. Now, the IAEA is leveraging both AI and XAI to improve the precision and efficiency of contouring tasks while also investigating the risk of bias being introduced by these technologies.

          The new CRP will examine how AI can assist with identifying gross tumour volumes. This recognition of both abnormal tissue and how much of its surroundings have been invaded is more challenging, since it requires a higher level of medical understanding and judgement.

          CRP Overall Objective:

          The CRP aims to improve the quality of radiotherapy contouring for head and neck cancer by assessing the impact of e-learning and deep learning-based auto-segmentation on inter-observer variation and bias when contouring gross tumour volume for advanced cases.

          The study will be conducted in two phases. The first phase it will compare AI assistance with and without explainability to manual contouring. The second phase will investigate bias risks with and without explainability. An optional third phase will explore how to best visualize and present these AI explanations.

          Participants in the project will be randomly assigned to groups for contouring tasks and will also take part in the IAEA led teaching sessions.

          How to join this CRP:

          This CRP is open to all Member States. Participating radiotherapy centres must meet the following eligibility criteria:

          • Treat at least 20 head and neck cancer patients each year.
          • Have 3D radiotherapy with computed tomography (CT)-based planning.
          • Possess a robust internet connection for online workshops, case uploads and downloads.
          • Have at least 3 to 4 oncologists who routinely perform head-and-neck cancer target contouring and who can participate.

          Research institutions interested in joining the CRP must submit their Proposal for Research Contract or Agreement via email, no later than 30 August 2025, to the IAEA’s Research Contracts Administration Section, using the appropriate template on the CRA web portal. The same template can be used for both the research contract and technical contract. The IAEA encourages institutes to involve, to the extent possible, women and young researchers in their proposals. For further information related to this CRP, potential applicants should use the contact form on the CRP page.

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