BACKGROUND: Accurate and consistent delineation of target and normal structures is essential for safe and effective radiotherapy. Compared with manual or atlas-based methods, deep learning-based auto-contouring has demonstrated improved efficiency and reduced interobserver variability. However, its performance can vary across anatomical regions and clinical contexts, and comprehensive multi-site validation remains limited. Existing studies have tended to assess only geometric similarity or a single region, providing insufficient insight into real-world usability and dosimetric influence. A systematic evaluation that integrates physician-based quality assessment, quantitative geometric metrics, and plan-level dosimetry across diverse anatomical sites is needed to support broader clinical implementation of deep learning-based auto-contouring for differentiation between target and normal structures. PURPOSE: To perform the first practice-oriented, cross-anatomical evaluation of the SYNAPSE Radiotherapy system (v1.5) and to assess its qualitative usability, geometric agreement (Dice similarity coefficient DSC, mean distance to agreement MDA, and maximum Hausdorff distance HD), and plan-level dosimetric impact across six anatomical sites. METHODS: We retrospectively analyzed data for 120 patients across six sites, namely, the head, head and neck, thorax, abdomen, male pelvis, and female pelvis. Thirty organs at risk were auto-segmented using the SYNAPSE Radiotherapy platform, and three board-certified radiation oncologists graded the clinical usability of the platform on a 4-point scale. Geometric agreement was quantified using the DSC, MDA, and maximum HD. Plan-level dosimetric comparisons were performed for representative targets. Institutional review board approval was obtained (number 2017-440). RESULTS: Overall, 76.1% of auto-contours were qualitatively judged to be clinically usable (score ≥3). Geometric thresholds were achieved for most structures (DSC > 0.8 in 54.8%, MDA < 2.5 mm in 71.5%, and maximum HD < 12.5 mm in 50%), with only 8/29 being major outliers. Auto-contours tended to be larger than manual contours in 72% of cases. Dosimetrically, 88.1% of organs showed dose-volume differences within ±5%, and dose constraint achievement rates were comparable between auto-contours and manual contours (93.9% vs. 95.%). Median doses to planning target volumes (e.g., prostate and iliac nodes) were also consistent, indicating minimal clinical impact. CONCLUSIONS: The SYNAPSE Radiotherapy system showed high overall clinical usability with organ-dependent variability. Our findings expand the platform-specific evidence for the SYNAPSE Radiotherapy system by linking geometry to dosimetric impact and supporting clinical deployment with an organ-specific quality assurance policy, while highlighting contexts in which targeted expert review remains necessary for safe clinical translation.
ENDO et al. (2026) studied this question.