Prostate cancer is one of the most frequently occurring types of cancer in males. It is often treated with radiation therapy, which aims at irradiating tumors with a high dose, while sparing the surrounding healthy tissues. In the course of the years, radiotherapy technology has undergone great advancements. However, tumors are not only different from each other, they are also highly heterogeneous within, consisting of regions with distinct tissue characteristics, which should be treated with different radiation doses. Tailoring radiotherapy planning to the specific needs and intra-tumor tissue characteristics of each patient is expected to lead to more effective treatment strategies. Currently, clinical research is moving towards this direction, but an understanding of the specific tumor characteristics of each patient, and the integration of all available knowledge into a personalizable radiotherapy planning pipeline are still required. The present work describes solutions from the field of Visual Analytics, which aim at incorporating the information from the distinct steps of the personalizable radiotherapy planning pipeline, along with eventual sources of uncertainty, into comprehensible visualizations. All proposed solutions are meant to increase the – up to now, limited – understanding and exploratory capabilities of clinical researchers. These approaches contribute towards the interactive exploration, visual analysis and understanding of the involved data and processes at different steps of the radiotherapy planning pipeline, creating a fertile ground for future research in radiotherapy planning.@en

We present the Bladder Runner, a novel tool to enable detailed visual exploration and analysis of the impact of bladder shape variation on the accuracy of dose delivery, during the course of prostate cancer radiotherapy (RT). Our tool enables the investigation of individual patients and cohorts through the entire treatment process, and it can give indications of RT‐induced complications for the patient. In prostate cancer RT treatment, despite the design of an initial plan prior to dose administration, bladder toxicity remains very common. The main reason is that the dose is delivered in multiple fractions over a period of weeks, during which, the anatomical variation of the bladder – due to differences in urinary filling – causes deviations between planned and delivered doses. Clinical researchers want to correlate bladder shape variations to dose deviations and toxicity risk through cohort studies, to understand which specific bladder shape characteristics are more prone to side effects. This is currently done with Dose‐Volume Histograms (DVHs), which provide limited, qualitative insight. The effect of bladder variation on dose delivery and the resulting toxicity cannot be currently examined with the DVHs. To address this need, we designed and implemented the Bladder Runner, which incorporates visualization strategies in a highly interactive environment with multiple linked views. Individual patients can be explored and analyzed through the entire treatment period, while inter‐patient and temporal exploration, analysis and comparison are also supported. We demonstrate the applicability of our presented tool with a usage scenario, employing a dataset of 29 patients followed through the course of the treatment, across 13 time points. We conducted an evaluation with three clinical researchers working on the investigation of RT‐induced bladder toxicity. All participants agreed that Bladder Runner provides better understanding and new opportunities for the exploration and analysis of the involved cohort data. @en

Functional imaging techniques provide radiobiological information that can be included into tumour control probability (TCP) models to enable individualized outcome predictions in radiotherapy. However, functional imaging and the derived radiobiological information are influenced by uncertainties, translating into variations in individual TCP predictions. In this study we applied a previously developed analytical tool to quantify dose and TCP uncertainty bands when initial cell density is estimated from MRI-based apparent diffusion coefficient maps of eleven patients. TCP uncertainty bands of 16% were observed at patient level, while dose variations bands up to 8 Gy were found at voxel level for an iso-TCP approach.@en

Parallel Coordinate Plots (PCPs) is one of the most powerful techniques for the visualization of multivariate data. However, for large datasets, the representation suffers from clutter due to overplotting. In this case, discerning the underlying data information and selecting specific interesting patterns can become difficult. We propose a new and simple technique to improve the display of PCPs by emphasizing the underlying data structure. Our Orientation-enhanced Parallel Coordinate Plots (OPCPs) improve pattern and outlier discernibility by visually enhancing parts of each PCP polyline with respect to its slope. This enhancement also allows us to introduce a novel and efficient selection method, the Orientation-enhanced Brushing (O-Brushing). Our solution is particularly useful when multiple patterns are present or when the view on certain patterns is obstructed by noise. We present the results of our approach with several synthetic and real-world datasets. Finally, we conducted a user evaluation, which verifies the advantages of the OPCPs in terms of discernibility of information in complex data. It also confirms that O-Brushing eases the selection of data patterns in PCPs and reduces the amount of necessary user interactions compared to state-of-the-art brushing techniques.@en

Accurate segmentation of brain white matter hyperintensities (WMHs) is important for prognosis and disease monitoring. To this end, classifiers are often trained – usually, using T1 and FLAIR weighted MR images. Incorporating additional features, derived from diffusion weighted MRI, could improve classification. However, the multitude of diffusion-derived features requires selecting the most adequate. For this, automated feature selection is commonly employed, which can often be sub-optimal. In this work, we propose a different approach, introducing a semi-automated pipeline to select interactively features for WMH classification. The advantage of this solution is the integration of the knowledge and skills of experts in the process. In our pipeline, a Visual Analytics (VA) system is employed, to enable user-driven feature selection. The resulting features are T1, FLAIR, Mean Diffusivity (MD), and Radial Diffusivity (RD) – and secondarily, C S  CS and Fractional Anisotropy (FA). The next step in the pipeline is to train a classifier with these features, and compare its results to a similar classifier, used in previous work with automated feature selection. Finally, VA is employed again, to analyze and understand the classifier performance and results.@en

Several diagnostic and treatment procedures require the segmentation of anatomical structures from medical images. However, the automatic model-based methods that are often employed, may produce inaccurate segmentations. These, if used as input for diagnosis or treatment, can have detrimental effects for the patients. Currently, an analysis to predict which anatomic regions are more prone to inaccuracies, and to determine how to improve segmentation algorithms, cannot be performed. We propose a visual tool to enable experts, working on model-based segmentation algorithms, to explore and analyze the outcomes and errors of their methods. Our approach supports the exploration of errors in a cohort of pelvic organ segmentations, where the performance of an algorithm can be assessed. Also, it enables the detailed exploration and assessment of segmentation errors, in individual subjects. To the best of our knowledge, there is no other tool with comparable functionality. A usage scenario is employed to explore and illustrate the capabilities of our visual tool. To further assess the value of the proposed tool, we performed an evaluation with five segmentation experts. The evaluation participants confirmed the potential of the tool in providing new insight into their data and employed algorithms. They also gave feedback for future improvements.@en

In radiotherapy, tumors are irradiated with a high dose, while surrounding healthy tissues are spared. To quantify the probability that a tumor is effectively treated with a given dose, statistical models were built and employed in clinical research. These are called tumor control probability (TCP) models. Recently, TCP models started incorporating additional information from imaging modalities. In this way, patient-specific properties of tumor tissues are included, improving the radiobiological accuracy of models. Yet, the employed imaging modalities are subject to uncertainties with significant impact on the modeling outcome, while the models are sensitive to a number of parameter assumptions. Currently, uncertainty and parameter sensitivity are not incorporated in the analysis, due to time and resource constraints. To this end, we propose a visual tool that enables clinical researchers working on TCP modeling, to explore the information provided by their models, to discover new knowledge and to confirm or generate hypotheses within their data. Our approach incorporates the following four main components: (1) It supports the exploration of uncertainty and its effect on TCP models; (2) It facilitates parameter sensitivity analysis to common assumptions; (3) It enables the identification of inter-patient response variability; (4) It allows starting the analysis from the desired treatment outcome, to identify treatment strategies that achieve it. We conducted an evaluation with nine clinical researchers. All participants agreed that the proposed visual tool provides better understanding and new opportunities for the exploration and analysis of TCP modeling. @en