Towards fast human-centered contouring workflows for adaptive external beam radiotherapy

Delineation of tumors and organs-at-risk permits detecting and correcting changes in the patients' anatomy throughout the treatment, making it a core step of adaptive external beam radiotherapy. Although auto-contouring technologies have sped up this process, the time needed to perform the quality assessment of the generated contours remains a bottleneck, taking clinicians between several minutes and an hour to complete. The authors of this article conducted several interviews and an observational study at two treatment centers in the Netherlands to identify challenges and opportunities for speeding up the delineation process in adaptive therapies. The study revealed three contextual variables that influence contouring performance: usable additional information, applicable domain-specific knowledge, and available editing capabilities in contouring software. In practice, clinicians leverage these variables to accelerate contouring in two ways. First, they use domain-specific knowledge and relevant clinical features such as the proximity of the organs-at-risk to the tumor to enable targeted inspection of the delineation. Second, clinicians modulate editing precision depending on the effect they anticipate the edit will have on the patient outcome. By implementing these acceleration strategies in guidelines and contouring tools, developers and workflow builders could increase contouring efficiency and consistency without affecting the patient outcome.

@InProceedings { CMHSADDE22,
  author       = "Chaves de Plaza, Nicolas and Mody, Prerak P. and Hildebrandt, Klaus and Staring, Marius and Astreinidou,
                  Eleftheria and de Ridder, Mischa and de Ridder,  Huib and Egmond, Ren\'e van",
  title        = "Towards fast human-centered contouring workflows for adaptive external beam radiotherapy",
  booktitle    = "Human Factors and Ergonomics Society Europe Chapter Annual Conference",
  year         = "2022",
  url          = "http://graphics.tudelft.nl/Publications-new/2022/CMHSADDE22"
}