Auto-Contouring QA Checklist

Automatic contours are proposals, not plans. This is the check to run before one reaches a treatment plan, ordered so the fastest disqualifying checks come first.

Before you review a single structure

1. Confirm the correct scan, series and patient orientation loaded.
2. Confirm the model is being used on anatomy and a protocol it was validated for.
3. Look for gross failures first — missing structures, structures generated outside the body contour, left/right transposition.

Structure by structure

• Targets. Never accept an auto-generated target volume without full clinical review.
• Serial organs at risk. Spinal cord, brainstem, optic structures — small errors carry the largest dosimetric consequence, so inspect slice by slice at the extremes.
• Boundaries by convention. Structures defined partly by anatomical convention rather than image contrast are where models and humans most often disagree.
• Superior and inferior extents. The commonest systematic error is a structure that is correct in the middle and wrong at both ends.
• Artefact regions. Dental artefact, prostheses and post-surgical anatomy degrade output disproportionately.

Before approval

• Every edited structure re-reviewed after editing, not only before.
• Clinician approval recorded, with the automatic origin of the contour visible in the record.
• Any systematic failure pattern reported back, so it is fixed rather than re-edited weekly.

The risk this workflow creates is automation bias: approving contours without real inspection because they usually look right. The checklist exists to make inspection routine.