New Insights into Automatic Treatment Planning for Cancer Radiotherapy Using Explainable Artificial Intelligence

Fuente: arXiv
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Main Authors: Abrar, Md Mainul, Jia, Xun, Chi, Yujie
Format: Preprint
Published: 2025
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author Abrar, Md Mainul
Jia, Xun
Chi, Yujie
author_facet Abrar, Md Mainul
Jia, Xun
Chi, Yujie
contents Objective: This study aims to uncover the opaque decision-making process of an artificial intelligence (AI) agent for automatic treatment planning. Approach: We examined a previously developed AI agent based on the Actor-Critic with Experience Replay (ACER) network, which automatically tunes treatment planning parameters (TPPs) for inverse planning in prostate cancer intensity modulated radiotherapy. We selected multiple checkpoint ACER agents from different stages of training and applied an explainable AI (EXAI) method to analyze the attribution from dose-volume histogram (DVH) inputs to TPP-tuning decisions. We then assessed each agent's planning efficacy and efficiency and evaluated their policy and final TPP tuning spaces. Combining these analyses, we systematically examined how ACER agents generated high-quality treatment plans in response to different DVH inputs. Results: Attribution analysis revealed that ACER agents progressively learned to identify dose-violation regions from DVH inputs and promote appropriate TPP-tuning actions to mitigate them. Organ-wise similarities between DVH attributions and dose-violation reductions ranged from 0.25 to 0.5 across tested agents. Agents with stronger attribution-violation similarity required fewer tuning steps (~12-13 vs. 22), exhibited a more concentrated TPP-tuning space with lower entropy (~0.3 vs. 0.6), converged on adjusting only a few TPPs, and showed smaller discrepancies between practical and theoretical tuning steps. Putting together, these findings indicate that high-performing ACER agents can effectively identify dose violations from DVH inputs and employ a global tuning strategy to achieve high-quality treatment planning, much like skilled human planners. Significance: Better interpretability of the agent's decision-making process may enhance clinician trust and inspire new strategies for automatic treatment planning.
format Preprint
id arxiv_https___arxiv_org_abs_2508_14229
institution arXiv
publishDate 2025
record_format arxiv
spellingShingle New Insights into Automatic Treatment Planning for Cancer Radiotherapy Using Explainable Artificial Intelligence
Abrar, Md Mainul
Jia, Xun
Chi, Yujie
Medical Physics
Artificial Intelligence
Primary 68T27, Secondary 68T99,
J.3; I.2.m
Objective: This study aims to uncover the opaque decision-making process of an artificial intelligence (AI) agent for automatic treatment planning. Approach: We examined a previously developed AI agent based on the Actor-Critic with Experience Replay (ACER) network, which automatically tunes treatment planning parameters (TPPs) for inverse planning in prostate cancer intensity modulated radiotherapy. We selected multiple checkpoint ACER agents from different stages of training and applied an explainable AI (EXAI) method to analyze the attribution from dose-volume histogram (DVH) inputs to TPP-tuning decisions. We then assessed each agent's planning efficacy and efficiency and evaluated their policy and final TPP tuning spaces. Combining these analyses, we systematically examined how ACER agents generated high-quality treatment plans in response to different DVH inputs. Results: Attribution analysis revealed that ACER agents progressively learned to identify dose-violation regions from DVH inputs and promote appropriate TPP-tuning actions to mitigate them. Organ-wise similarities between DVH attributions and dose-violation reductions ranged from 0.25 to 0.5 across tested agents. Agents with stronger attribution-violation similarity required fewer tuning steps (~12-13 vs. 22), exhibited a more concentrated TPP-tuning space with lower entropy (~0.3 vs. 0.6), converged on adjusting only a few TPPs, and showed smaller discrepancies between practical and theoretical tuning steps. Putting together, these findings indicate that high-performing ACER agents can effectively identify dose violations from DVH inputs and employ a global tuning strategy to achieve high-quality treatment planning, much like skilled human planners. Significance: Better interpretability of the agent's decision-making process may enhance clinician trust and inspire new strategies for automatic treatment planning.
title New Insights into Automatic Treatment Planning for Cancer Radiotherapy Using Explainable Artificial Intelligence
topic Medical Physics
Artificial Intelligence
Primary 68T27, Secondary 68T99,
J.3; I.2.m
url https://arxiv.org/abs/2508.14229