Uncertainty guidance in proton therapy planning visualization

Abstract

We investigate uncertainty guidance mechanisms to support proton therapy (PT) planning visualization. Uncertainties in the PT workflow pose significant challenges for navigating treatment plan data and selecting the most optimal plan among alternatives. Although guidance techniques have not yet been applied to PT planning scenarios, they have successfully supported sense- and decision-making processes in other contexts. We hypothesize that augmenting PT uncertainty visualization with guidance may influence the intended users' perceived confidence and provide new insights. To this end, we follow an iterative co-design process with domain experts to develop a visualization dashboard enhanced with distinct level-of-detail uncertainty guidance mechanisms. Our approach classifies uncertainty guidance into two dimensions: degree of intrusiveness and detail-orientation. Our dashboard supports the comparison of multiple treatment plans (i.e., nominal plans with their translational variations) while accounting for multiple uncertainty factors. We subsequently evaluate the designed and developed strategies by assessing perceived confidence and effectiveness during a sense- and decision-making process. Our findings indicate that uncertainty guidance in PT planning visualization does not necessarily impact the perceived confidence of the users in the process. Nonetheless, it provides new insights and raises uncertainty awareness during treatment plan selection. This observation was particularly evident for users with longer experience in PT planning.