Deep learning approach has been demonstrated to automatically segment the bilateral mandibular canals from CBCT scans, yet systematic studies of its clinical and technical validation are scarce. To validate the mandibular canal localization accuracy of a deep learning system (DLS) we trained it with 982 CBCT scans and evaluated using 150 scans of five scanners from clinical workflow patients of European and Southeast Asian Institutes, annotated by four radiologists. The interobserver variability was compared to the variability between the DLS and the radiologists. In addition, the generalization of DLS to CBCT scans from scanners not used in the training data was examined to evaluate the out-of-distribution generalization capability. The DLS had lower variability to the radiologists than the interobserver variability between them and it was able to generalize to three new devices. For the radiologists' consensus segmentation, used as gold standard, the DLS had a symmetric mean curve distance of 0.39 mm compared to those of the individual radiologists with 0.62 mm, 0.55 mm, 0.47 mm, and 0.42 mm. The DLS showed comparable or slightly better performance in the segmentation of the mandibular canal with the radiologists and generalization capability to new scanners.
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