Abstract
Deep learning based auto segmentation is increasingly used in radiotherapy, but conventional models often produce anatomically implausible false positives, or hallucinations, in slices lacking target structures. We propose a gated multi-head Transformer architecture based on Swin U-Net, augmented with inter-slice context integration and a parallel detection head, which jointly performs slice-level structure detection via a multi-layer perceptron and pixel-level segmentation through a context-enhanced stream. Detection outputs gate the segmentation predictions to suppress false positives in anatomically invalid slices, and training uses slice-wise Tversky loss to address class imbalance. Experiments on the Prostate-Anatomical-Edge-Cases dataset from The Cancer Imaging Archive demonstrate that the gated model substantially outperforms a non-gated segmentation-only baseline, achieving a mean Dice loss of $0.013 \pm 0.036$ versus $0.732 \pm 0.314$, with detection probabilities strongly correlated with anatomical presence, effectively eliminating spurious segmentations. In contrast, the non-gated model exhibited higher variability and persistent false positives across all slices. These results indicate that detection-based gating enhances robustness and anatomical plausibility in automated segmentation applications, reducing hallucinated predictions without compromising segmentation quality in valid slices, and offers a promising approach for improving the reliability of clinical radiotherapy auto-contouring workflows.
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URL
https://arxiv.org/abs/2602.02471
