Clinical impact of introducing automated plan checking in radiation therapy: effects on workflow efficiency, cognitive load and usability.

As radiation therapy planning becomes increasingly complex, the risk of human error and the workload associated with plan checking have intensified for medical physicists. This study aimed to develop an automated plan check script using the Eclipse Scripting API and to quantitatively evaluate its impact on workflow efficiency, subjective operator workload and system usability in a clinical setting. A script was developed in C# to automatically verify treatment parameters, naming conventions and data consistency and to generate standardized PDF reports. Four experienced medical physicists performed plan checks on nine representative clinical cases using both conventional manual checks and script-assisted checks in a randomized order. The total time required to complete the plan check process was measured for each trial. Subjective workload was assessed using the NASA Task Load Index, and system usability was evaluated using the System Usability Scale. Script-assisted checks significantly reduced the mean plan check time compared with manual checks (418.6 ± 48.8 s vs 549.9 ± 52.5 s, P = 0.0039), corresponding to an average reduction of 131.3 s (23.9%) per case, with a maximum reduction of ~4 min in complex cases such as electron therapy. NASA Task Load Index scores demonstrated notable reductions in effort, frustration and mental demand while maintaining high performance levels. System Usability Scale results indicated high usability, learnability and operator confidence. Automated plan checking effectively improves workflow efficiency while reducing cognitive and psychological burden, which may support a more standardized quality assurance workflow in radiation therapy planning.