End-user validation of BRIGHT with custom-developed graphical user interface applied to cervical cancer brachytherapy

TL;DR

A novel, custom-developed graphical user interface (GUI) that enables plan navigation, pairwise comparisons, dose distribution visualisation, and possibility for adjustments - essential for efficient clinical use of BRIGHT is presented.

Abstract

Multi-objective optimisation using BRIGHT has proven insightful and effective in prostate cancer brachytherapy treatment planning. BRachytherapy via artificially Intelligent GOMEA-Heuristic based Treatment planning (BRIGHT) generates multiple treatment plans, each with a different trade-off between tumour coverage and organs-at-risk sparing. BRIGHT was recently extended to cervical cancer brachytherapy. In this study, we present a novel, custom-developed graphical user interface (GUI) that enables plan navigation, pairwise comparisons, dose distribution visualisation, and possibility for adjustments - essential for efficient clinical use of BRIGHT. End-user validation of BRIGHT with the dedicated GUI was conducted for cervical cancer brachytherapy by emulating clinical practice in ten previously treated patients. A multidisciplinary brachytherapy team used BRIGHT to create new treatment plans. GUI usability was assessed using the System Usability Scale (SUS). BRIGHT plan quality was compared to clinical practice via blinded one-on-one comparisons. The GUI offered helpful features for plan navigation and evaluation, giving users quick insight into whether planning aims are achievable and what treatment options are available. The overall SUS score was 83.3, indicating an 'excellent' system. BRIGHT outperformed clinical practice in five out of ten patients regarding the coverage-sparing trade-off and performed equally well in the remaining five. The BRIGHT plan was preferred over the clinical plan in eight out of ten patients, four of which showed clinically relevant differences. The clinical plan was preferred in two patients, neither with clinically relevant differences. In conclusion, BRIGHT, with its dedicated GUI, is a clinically viable and user-friendly tool for treatment planning in cervical cancer brachytherapy.

Figures (7)

• Figure 1: Main window of the BRIGHT GUI. The numbered subparts refer to the subsections in which they are further explained. Subparts 2.1.2 and 2.1.3 are for treatment plan navigation and selection, whereas the other subparts aid in treatment plan evaluation. The three images show the different regions of interest as a delineated colorwash (legend: top right), superposed with isodose lines depicting areas receiving the same radiation dose (legend: mid right, in % of the prescription dose of 7 Gy).
• Figure 2: Catheter time chart with distribution of dwell times associated with the separate ovoids, the intrauterine applicator, and the needles.
• Figure 3: Tab in the BRIGHT GUI allowing for one-on-one plan comparison with a (retractable) middle view corresponding to the difference in dose between the two plans as a colourwash, with green representing a higher dose from the right plan, and purple a higher dose from the left plan. All dose aims from EMBRACE-II are given side by side in a table, in physical dose, and total EQD2 in brackets. The legend of the ROIs and isodose lines can be found in Figure \ref{['fig:mainwindow']}
• Figure 4: Re-optimisation settings window.
• Figure 5: Workflow for BRIGHT treatment plan selection (and adjustments). Steps shown in grey are optional. See dicom-obj-def for explanations of the DICOM standard.