Implementation of delineation error detection systems in time-critical radiotherapy: Do AI-supported optimization and human preferences meet?

Artificial Intelligence (AI)-based auto-delineation technologies rapidly delineate multiple structures of interest like organs-at-risk and tumors in 3D medical images, reducing personnel load and facilitating time-critical therapies. Despite its accuracy, the AI may produce flawed delineations, requiring clinician attention. Quality assessment (QA) of these delineations is laborious and demanding. Delineation error detection systems (DEDS) aim to aid QA, yet questions linger about potential challenges to their adoption and time-saving potential. To address these queries, we first conducted a user study with two clinicians from Holland Proton Therapy Center, a Dutch cancer treatment center. Based on the study’s findings about the clinicians’ error detection workflows with and without DEDS assistance, we developed a simulation model of the QA process, which we used to assess different error detection workflows on a retrospective cohort of 42 head and neck cancer patients. Results suggest possible time savings, provided the per-slice analysis time stays close to the current baseline and trading-off delineation quality is acceptable. Our findings encourage the development of user-centric delineation error detection systems and provide a new way to model and evaluate these systems’ potential clinical value.