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Abstract: PurposeThe trend towards lower radiation doses and advances in computed tomography (CT) reconstruction may impair the operation of pretrained segmentation models, giving rise to the problem of estimating the dose robustness of existing segmentation models. Previous studies addressing the issue suffer either from a lack of registered low- and full-dose CT images or from simplified simulations.ApproachWe employed raw data from full-dose acquisitions to simulate low-dose CT scans, avoiding the need to rescan a patient. The accuracy of the simulation is validated using a real CT scan of a phantom. We consider down to 20% reduction of radiation dose, for which we measure deviations of several pretrained segmentation models from the full-dose prediction. In addition, compatibility with existing denoising methods is considered.ResultsThe results reveal the surprising robustness of the TotalSegmentator approach, showing minimal differences at the pixel level even without denoising. Less robust models show good compatibility with the denoising methods, which help to improve robustness in almost all cases. With denoising based on a convolutional neural network (CNN), the median Dice between low- and full-dose data does not fall below 0.9 (12 for the Hausdorff distance) for all but one model. We observe volatile results for labels with effective radii less than 19 mm and improved results for contrasted CT acquisitions.ConclusionThe proposed approach facilitates clinically relevant analysis of dose robustness for human organ segmentation models. The results outline the robustness properties of a diverse set of models. Further studies are needed to identify the robustness of approaches for lesion segmentation and to rank the factors contributing to dose robustness.