OBJECTIVE: High-dose-rate (HDR) brachytherapy is integral to the standard-of-care for locally advanced cervical cancer (LACC). Currently, selection of brachytherapy applicators relies on physician's clinical experience, which can lead to variability in treatment quality and outcomes. This study presents a deep learning-based decision-support tool for selecting between interstitial Syed applicators and intracavitary tandem & ovoids applicators.

APPROACH: The network architecture consists of six 3D convolutional-pooling-ReLU blocks, followed by a fully connected block. The input to the network includes three channels: a 3D contour mask of clinical target volume (CTV), organs at risk (OAR), and central tandem, and two 3D distance maps of CTV and OAR voxels relative to the tandem's central axis. The network outputs a probability score, indicating the suitability of Syed applicators. Binary cross-entropy loss combined with L1 regularization was used for network training.

MAIN RESULTS: A retrospective study was performed on 184 LACC patients with 422 instances of applicator insertion. The data was divided into three sets: Dataset-1 of 163 patients with 372 insertions for training and hyperparameter tuning, Dataset-2 of 17 patients with 36 insertions and Dataset-3 of four complex cases with 14 insertions for testing. Five-fold cross-validation was performed on Dataset-1, during which hyperparameters were heuristically tuned to optimize classification accuracy across the folds. The highest average accuracy was 92.1 ± 3.8%. Using the hyperparameters that resulted in this highest accuracy, the final model was then trained on the full Dataset-1, and evaluated on the other two independent datasets, achieving 96.0% accuracy, 90.9% sensitivity, and 97.4% specificity.

SIGNIFICANCE: These results demonstrate the potential of our model as a quality assurance tool in LACC HDR brachytherapy, providing feedback on physicians' applicator choice and supporting continuous improvement in decision-making. Future work will focus on collecting more data for further validation and extending its application for prospective applicator selection.