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deep learning monte carlo head neck ground truth organs risk machine learning normal tissue computed tomography neural network statistically significant soft tissue carlo simulations dice similarity noise ratio online adaptive significant differences auto segmentation standard deviation risk oars gamma passing cross validation stereotactic radiosurgery stereotactic body intensity modulated signal noise oar sparing spatial resolution deformable registration similarity coefficient spinal cord organ risk gamma knife photon counting bragg peak ptv coverage passing rates sensitivity specificity coefficient dsc contrast enhanced field size carlo simulation hausdorff distance decision making aims develop risk oar dna damage linear accelerator pencil scanning fold cross dual energy