BAT-RM: A Boundary-Aware Transformer with Region-Aware Multi-Directional Mamba for Clinically Deployed Cervical Cancer Radiotherapy Auto-Contouring

• URL: http://arxiv.org/abs/2607.11949v1
• Date: Sat, 11 Jul 2026 16:58:34 GMT
• Title: BAT-RM: A Boundary-Aware Transformer with Region-Aware Multi-Directional Mamba for Clinically Deployed Cervical Cancer Radiotherapy Auto-Contouring
• Abstract summary: We present a clinically deployed end-to-end auto-contouring system for cervical cancer radiotherapy planning.<n>This architecture integrates Sobel-gated boundary attention, a linear-time, multi-directional Mamba module for long-range context, and a boundary-skeleton-guided fusion gate.
• Score: 2.1332035830532523
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: We present a clinically deployed end-to-end auto-contouring system for cervical cancer radiotherapy planning, anchored by the Boundary-Aware Transformer with Region-Aware Mamba (BAT-RM), a hybrid architecture that integrates Sobel-gated boundary attention, a linear-time, multi-directional Mamba module for long-range context, and a boundary-skeleton-guided fusion gate. This design achieves linear-time complexity for long-range context modeling, avoiding the quadratic cost of full spatial self-attention. The full pipeline spans multi-institutional data collection, rigorous inter-rater quality assurance, external validation in an independent cohort, and a web-based clinical interface natively compatible with Varian, RayStation, and Monaco. Against four baselines, BAT-RM achieves superior performance across seven anatomical classes, with statistically significant improvements in target volumes, including GTV and CTV, and in organs at risk such as the rectum and bladder. A prospective multi-center reader study involving 13 radiation oncologists demonstrated that AI assistance elevates junior oncologists' IoU from 0.899 to 0.965, approaching senior-level accuracy, while reducing contouring time by more than 80%. The system also reduced expert consultation rates and improved inter-reader consistency, reflecting gains in both efficiency and quality assurance. Following clinical deployment at a partner hospital, the system reduced patient wait times from days to hours without additional staffing, enabling same-day or next-day initiation of treatment for routine cases. BAT-RM demonstrates that a rigorous research pipeline, from data curation to clinical deployment, can translate directly into measurable patient benefit in resource-constrained settings where the demand for radiotherapy far exceeds specialist capacity.

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