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AKÇAY M, ETİZ D. Radyasyon Onkolojisinde Makine Öğrenmesi. OSMANGAZİ JOURNAL OF MEDICINE 2020. [DOI: 10.20515/otd.691331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Albertini F, Matter M, Nenoff L, Zhang Y, Lomax A. Online daily adaptive proton therapy. Br J Radiol 2020; 93:20190594. [PMID: 31647313 PMCID: PMC7066958 DOI: 10.1259/bjr.20190594] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is recognized that the use of a single plan calculated on an image acquired some time before the treatment is generally insufficient to accurately represent the daily dose to the target and to the organs at risk. This is particularly true for protons, due to the physical finite range. Although this characteristic enables the generation of steep dose gradients, which is essential for highly conformal radiotherapy, it also tightens the dependency of the delivered dose to the range accuracy. In particular, the use of an outdated patient anatomy is one of the most significant sources of range inaccuracy, thus affecting the quality of the planned dose distribution. A plan should be ideally adapted as soon as anatomical variations occur, ideally online. In this review, we describe in detail the different steps of the adaptive workflow and discuss the challenges and corresponding state-of-the art developments in particular for an online adaptive strategy.
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Affiliation(s)
| | | | | | - Ye Zhang
- Paul Scherrer Institute, Center for Proton Therapy, Switzerland
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Chamunyonga C, Edwards C, Caldwell P, Rutledge P, Burbery J. The Impact of Artificial Intelligence and Machine Learning in Radiation Therapy: Considerations for Future Curriculum Enhancement. J Med Imaging Radiat Sci 2020; 51:214-220. [PMID: 32115386 DOI: 10.1016/j.jmir.2020.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/31/2020] [Accepted: 01/31/2020] [Indexed: 12/14/2022]
Abstract
Artificial intelligence (AI) and machine learning (ML) approaches have caught the attention of many in health care. Current literature suggests there are many potential benefits that could transform future clinical workflows and decision making. Embedding AI and ML concepts in radiation therapy education could be a fundamental step in equipping radiation therapists (RTs) to engage in competent and safe practice as they utilise clinical technologies. In this discussion paper, the authors provide a brief review of some applications of AI and ML in radiation therapy and discuss pertinent considerations for radiation therapy curriculum enhancement. As the current literature suggests, AI and ML approaches will impose changes to routine clinical radiation therapy tasks. The emphasis in RT education could be on critical evaluation of AI and ML application in routine clinical workflows and gaining an understanding of the impact on quality assurance, provision of quality of care and safety in radiation therapy as well as research. It is also imperative RTs have a broader understanding of AI/ML impact on health care, including ethical and legal considerations. The paper concludes with recommendations and suggestions to deliberately embed AI and ML aspects in RT education to empower future RT practitioners.
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Affiliation(s)
- Crispen Chamunyonga
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Christopher Edwards
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Caldwell
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peta Rutledge
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Burbery
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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Wang C, Zhu X, Hong JC, Zheng D. Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future. Technol Cancer Res Treat 2020; 18:1533033819873922. [PMID: 31495281 PMCID: PMC6732844 DOI: 10.1177/1533033819873922] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Treatment planning is an essential step of the radiotherapy workflow. It has become more sophisticated over the past couple of decades with the help of computer science, enabling planners to design highly complex radiotherapy plans to minimize the normal tissue damage while persevering sufficient tumor control. As a result, treatment planning has become more labor intensive, requiring hours or even days of planner effort to optimize an individual patient case in a trial-and-error fashion. More recently, artificial intelligence has been utilized to automate and improve various aspects of medical science. For radiotherapy treatment planning, many algorithms have been developed to better support planners. These algorithms focus on automating the planning process and/or optimizing dosimetric trade-offs, and they have already made great impact on improving treatment planning efficiency and plan quality consistency. In this review, the smart planning tools in current clinical use are summarized in 3 main categories: automated rule implementation and reasoning, modeling of prior knowledge in clinical practice, and multicriteria optimization. Novel artificial intelligence-based treatment planning applications, such as deep learning-based algorithms and emerging research directions, are also reviewed. Finally, the challenges of artificial intelligence-based treatment planning are discussed for future works.
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Affiliation(s)
- Chunhao Wang
- 1 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Xiaofeng Zhu
- 2 Department of Radiation Oncology, Georgetown University Hospital, Rockville, MD, USA
| | - Julian C Hong
- 1 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.,3 Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Dandan Zheng
- 4 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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El Naqa I, Haider MA, Giger ML, Ten Haken RK. Artificial Intelligence: reshaping the practice of radiological sciences in the 21st century. Br J Radiol 2020; 93:20190855. [PMID: 31965813 PMCID: PMC7055429 DOI: 10.1259/bjr.20190855] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
Advances in computing hardware and software platforms have led to the recent resurgence in artificial intelligence (AI) touching almost every aspect of our daily lives by its capability for automating complex tasks or providing superior predictive analytics. AI applications are currently spanning many diverse fields from economics to entertainment, to manufacturing, as well as medicine. Since modern AI's inception decades ago, practitioners in radiological sciences have been pioneering its development and implementation in medicine, particularly in areas related to diagnostic imaging and therapy. In this anniversary article, we embark on a journey to reflect on the learned lessons from past AI's chequered history. We further summarize the current status of AI in radiological sciences, highlighting, with examples, its impressive achievements and effect on re-shaping the practice of medical imaging and radiotherapy in the areas of computer-aided detection, diagnosis, prognosis, and decision support. Moving beyond the commercial hype of AI into reality, we discuss the current challenges to overcome, for AI to achieve its promised hope of providing better precision healthcare for each patient while reducing cost burden on their families and the society at large.
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Affiliation(s)
- Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Masoom A Haider
- Department of Medical Imaging and Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Deig CR, Kanwar A, Thompson RF. Artificial Intelligence in Radiation Oncology. Hematol Oncol Clin North Am 2019; 33:1095-1104. [PMID: 31668208 DOI: 10.1016/j.hoc.2019.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The integration of artificial intelligence in the radiation oncologist's workflow has multiple applications and significant potential. From the initial patient encounter, artificial intelligence may aid in pretreatment disease outcome and toxicity prediction. It may subsequently aid in treatment planning, and enhanced dose optimization. Artificial intelligence may also optimize the quality assurance process and support a higher level of safety, quality, and efficiency of care. This article describes components of the radiation consultation, planning, and treatment process and how the thoughtful integration of artificial intelligence may improve shared decision making, planning efficiency, planning quality, patient safety, and patient outcomes.
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Affiliation(s)
- Christopher R Deig
- Radiation Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Aasheesh Kanwar
- Radiation Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Reid F Thompson
- Radiation Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Hospital & Specialty Medicine, VA Portland Healthcare System, 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA.
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Pillai M, Adapa K, Das SK, Mazur L, Dooley J, Marks LB, Thompson RF, Chera BS. Using Artificial Intelligence to Improve the Quality and Safety of Radiation Therapy. J Am Coll Radiol 2019; 16:1267-1272. [DOI: 10.1016/j.jacr.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023]
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Malone C, Fennell L, Folliard T, Kelly C. Using a neural network to predict deviations in mean heart dose during the treatment of left-sided deep inspiration breath hold patients. Phys Med 2019; 65:137-142. [PMID: 31465979 DOI: 10.1016/j.ejmp.2019.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE We investigated if a neural network could be used to predict the change in mean heart dose when a patient's heart deviates from its planned position during radiotherapy treatment. METHODS Predictions were made based on parameters available at the time of treatment planning. The dose prescription, deep inspiration breath-hold (DIBH) amplitude, heart volume, lung volume, V90% and mean heart dose were used to predict the increase in dose to the heart when a shift towards the treatment field was undertaken. The network was trained using 3 mm, 5 mm and 7 mm shifts in heart positions for 50 patients' giving 150 data points in total. The neural network architecture was also varied to find the most optimal network design. The final neural network was then tested using cross-validation to evaluate the model's ability to generalise to new data. RESULTS The optimal neural network found was comprised of a single hidden layer of 30 neurons. Based on twenty train/test splits, 94% of all prediction errors were below 0.2 Gy, 97.3% were below 0.3 Gy and 100% were below 0.5 Gy. The average RMSE and maximum prediction error over all train/test splits were 0.13 Gy and 0.5 Gy respectively. CONCLUSIONS Our approach using a neural network provides a clinically acceptable estimate of the increase in Mean Heart Dose (MHD), without the need for further imaging, contouring or evaluation. The trained neural network gives clinicians the information and tools required to evaluate what shift in heart position would be acceptable and which scenarios require immediate action before treatment continues.
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Affiliation(s)
| | | | | | - Colin Kelly
- St. Luke's Radiation Oncology Network, Ireland.
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Sheikh K, Lee SH, Cheng Z, Lakshminarayanan P, Peng L, Han P, McNutt TR, Quon H, Lee J. Predicting acute radiation induced xerostomia in head and neck Cancer using MR and CT Radiomics of parotid and submandibular glands. Radiat Oncol 2019; 14:131. [PMID: 31358029 PMCID: PMC6664784 DOI: 10.1186/s13014-019-1339-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/17/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To analyze baseline CT/MR-based image features of salivary glands to predict radiation-induced xerostomia 3-months after head-and-neck cancer (HNC) radiotherapy. METHODS A retrospective analysis was performed on 266 HNC patients who were treated using radiotherapy at our institution between 2009 and 2018. CT and T1 post-contrast MR images along with NCI-CTCAE xerostomia grade (3-month follow-up) were prospectively collected at our institution. CT and MR images were registered on which parotid/submandibular glands were contoured. Image features were extracted for ipsilateral/contralateral parotid and submandibular glands relative to the location of the primary tumor. Dose-volume-histogram (DVH) parameters were also acquired. Features were pre-selected based on Spearman correlation before modelling by examining the correlation with xerostomia (p < 0.05). A shrinkage regression analysis of the pre-selected features was performed using LASSO. The internal validity of the variable selection was estimated by repeating the entire variable selection procedure using a leave-one-out-cross-validation. The most frequently selected variables were considered in the final model. A generalized linear regression with repeated ten-fold cross-validation was developed to predict radiation-induced xerostomia at 3-months after radiotherapy. This model was tested in an independent dataset (n = 50) of patients who were treated at the same institution in 2017-2018. We compared the prediction performances under eight conditions (DVH-only, CT-only, MR-only, CT + MR, DVH + CT, DVH + CT + MR, Clinical+CT + MR, and Clinical+DVH + CT + MR) using the area under the receiver operating characteristic curve (ROC-AUC). RESULTS Among extracted features, 7 CT, 5 MR, and 2 DVH features were selected. The internal cohort (n = 216) ROC-AUC values for DVH, CT, MR, and Clinical+DVH + CT + MR features were 0.73 ± 0.01, 0.69 ± 0.01, 0.70 ± 0.01, and 0.79 ± 0.01, respectively. The validation cohort (n = 50) ROC-AUC values for DVH, CT, MR, and Clinical+DVH + CT + MR features were 0.63, 0.57, 0.66, and 0.68, respectively. The DVH-ROC was not significantly different than the CT-ROC (p = 0.8) or MR-ROC (p = 0.4). However, the CT + MR-ROC was significantly different than the CT-ROC (p = 0.03), but not the Clinical+DVH + CT + MR model (p = 0.5). CONCLUSION Our results suggest that baseline CT and MR image features may reflect baseline salivary gland function and potential risk for radiation injury. The integration of baseline image features into prediction models has the potential to improve xerostomia risk stratification with the ultimate goal of truly personalized HNC radiotherapy.
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Affiliation(s)
- Khadija Sheikh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Sang Ho Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Pranav Lakshminarayanan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Luke Peng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Peijin Han
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Todd R. McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21287-5678 USA
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Luo Y, Tseng HH, Cui S, Wei L, Ten Haken RK, El Naqa I. Balancing accuracy and interpretability of machine learning approaches for radiation treatment outcomes modeling. BJR Open 2019; 1:20190021. [PMID: 33178948 PMCID: PMC7592485 DOI: 10.1259/bjro.20190021] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 12/17/2022] Open
Abstract
Radiation outcomes prediction (ROP) plays an important role in personalized prescription and adaptive radiotherapy. A clinical decision may not only depend on an accurate radiation outcomes’ prediction, but also needs to be made based on an informed understanding of the relationship among patients’ characteristics, radiation response and treatment plans. As more patients’ biophysical information become available, machine learning (ML) techniques will have a great potential for improving ROP. Creating explainable ML methods is an ultimate task for clinical practice but remains a challenging one. Towards complete explainability, the interpretability of ML approaches needs to be first explored. Hence, this review focuses on the application of ML techniques for clinical adoption in radiation oncology by balancing accuracy with interpretability of the predictive model of interest. An ML algorithm can be generally classified into an interpretable (IP) or non-interpretable (NIP) (“black box”) technique. While the former may provide a clearer explanation to aid clinical decision-making, its prediction performance is generally outperformed by the latter. Therefore, great efforts and resources have been dedicated towards balancing the accuracy and the interpretability of ML approaches in ROP, but more still needs to be done. In this review, current progress to increase the accuracy for IP ML approaches is introduced, and major trends to improve the interpretability and alleviate the “black box” stigma of ML in radiation outcomes modeling are summarized. Efforts to integrate IP and NIP ML approaches to produce predictive models with higher accuracy and interpretability for ROP are also discussed.
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Affiliation(s)
- Yi Luo
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
| | - Huan-Hsin Tseng
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
| | - Sunan Cui
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
| | - Lise Wei
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, 519 W William Street, Ann Arbor, MI, USA
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Jarrett D, Stride E, Vallis K, Gooding MJ. Applications and limitations of machine learning in radiation oncology. Br J Radiol 2019; 92:20190001. [PMID: 31112393 PMCID: PMC6724618 DOI: 10.1259/bjr.20190001] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Machine learning approaches to problem-solving are growing rapidly within healthcare, and radiation oncology is no exception. With the burgeoning interest in machine learning comes the significant risk of misaligned expectations as to what it can and cannot accomplish. This paper evaluates the role of machine learning and the problems it solves within the context of current clinical challenges in radiation oncology. The role of learning algorithms within the workflow for external beam radiation therapy are surveyed, considering simulation imaging, multimodal fusion, image segmentation, treatment planning, quality assurance, and treatment delivery and adaptation. For each aspect, the clinical challenges faced, the learning algorithms proposed, and the successes and limitations of various approaches are analyzed. It is observed that machine learning has largely thrived on reproducibly mimicking conventional human-driven solutions with more efficiency and consistency. On the other hand, since algorithms are generally trained using expert opinion as ground truth, machine learning is of limited utility where problems or ground truths are not well-defined, or if suitable measures of correctness are not available. As a result, machines may excel at replicating, automating and standardizing human behaviour on manual chores, meanwhile the conceptual clinical challenges relating to definition, evaluation, and judgement remain in the realm of human intelligence and insight.
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Affiliation(s)
- Daniel Jarrett
- 1 Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, UK.,2 Mirada Medical Ltd, Oxford, UK
| | - Eleanor Stride
- 1 Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, UK
| | - Katherine Vallis
- 3 Department of Oncology, Oxford Institute for Radiation Oncology, University of Oxford, UK
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Rattan R, Kataria T, Banerjee S, Goyal S, Gupta D, Pandita A, Bisht S, Narang K, Mishra SR. Artificial intelligence in oncology, its scope and future prospects with specific reference to radiation oncology. BJR Open 2019; 1:20180031. [PMID: 33178922 PMCID: PMC7592433 DOI: 10.1259/bjro.20180031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Artificial intelligence (AI) seems to be bridging the gap between the acquisition of data and its meaningful interpretation. These approaches, have shown outstanding capabilities, outperforming most classification and regression methods to date and the ability to automatically learn the most suitable data representation for the task at hand and present it for better correlation. This article tries to sensitize the practising radiation oncologists to understand where the potential role of AI lies and what further can be achieved with it. METHODS AND MATERIALS Contemporary literature was searched and the available literature was sorted and an attempt at writing a comprehensive non-systematic review was made. RESULTS The article addresses various areas in oncology, especially in the field of radiation oncology, where the work based on AI has been done. Whether it's the screening modalities, or diagnosis or the prognostic assays, AI has come with more accurately defining results and survival of patients. Various steps and protocols in radiation oncology are now using AI-based methods, like in the steps of planning, segmentation and delivery of radiation. Benefit of AI across all the platforms of health sector may lead to a more refined and personalized medicine in near future. CONCLUSION AI with the use of machine learning and artificial neural networks has come up with faster and more accurate solutions for the problems faced by oncologist. The uses of AI,are likely to get increased exponentially . However, concerns regarding demographic discrepancies in relation to patients, disease and their natural history and reports of manipulation of AI, the ultimate responsibility will rest on the treating physicians.
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Affiliation(s)
- Rajit Rattan
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shikha Goyal
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Akshi Pandita
- Department of Dermatology, P. N. Behl Skin Institute, New Delhi, India
| | - Shyam Bisht
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
- Department of Dermatology, P. N. Behl Skin Institute, New Delhi, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
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Tetar SU, Bruynzeel AME, Lagerwaard FJ, Slotman BJ, Bohoudi O, Palacios MA. Clinical implementation of magnetic resonance imaging guided adaptive radiotherapy for localized prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 9:69-76. [PMID: 33458428 PMCID: PMC7807673 DOI: 10.1016/j.phro.2019.02.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
Background and purpose Magnetic resonance-guided radiation therapy (MRgRT) has recently become available in clinical practice and is expected to expand significantly in coming years. MRgRT offers marker-less continuous imaging during treatment delivery, use of small clinical target volume (CTV) to planning target volume (PTV) margins, and finally the option to perform daily plan re-optimization. Materials and methods A total of 140 patients (700 fractions) have been treated with MRgRT and online plan adaptation for localized prostate cancer since early 2016. Clinical workflow for MRgRT of prostate cancer consisted of patient selection, simulation on both MR- and computed tomography (CT) scan, inverse intensity-modulated radiotherapy (IMRT) treatment planning and daily plan re-optimization prior to treatment delivery with partial organs at risk (OAR) recontouring within the first 2 cm outside the PTV. For each adapted plan online patient-specific quality assurance (QA) was performed by means of a secondary Monte Carlo 3D dose calculation and gamma analysis comparison. Patient experiences with MRgRT were assessed using a patient-reported outcome questionnaire (PRO-Q) after the last fraction. Results In 97% of fractions, MRgRT was delivered using the online adapted plan. Intrafractional prostate drifts necessitated 2D-corrections during treatment in approximately 20% of fractions. The average duration of an uneventful fraction of MRgRT was 45 min. PRO-Q’s (N = 89) showed that MRgRT was generally well tolerated, with disturbing noise sensations being most commonly reported. Conclusions MRgRT with daily online plan adaptation constitutes an innovative approach for delivering SBRT for prostate cancer and appears to be feasible, although necessitating extended timeslots and logistical challenges.
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Affiliation(s)
- Shyama U Tetar
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ben J Slotman
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Omar Bohoudi
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Miguel A Palacios
- Dept. of Radiation Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Avanzo M, Pirrone G, Mileto M, Massarut S, Stancanello J, Baradaran-Ghahfarokhi M, Rink A, Barresi L, Vinante L, Piccoli E, Trovo M, El Naqa I, Sartor G. Prediction of skin dose in low-kV intraoperative radiotherapy using machine learning models trained on results of in vivo dosimetry. Med Phys 2019; 46:1447-1454. [PMID: 30620412 DOI: 10.1002/mp.13379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The purpose of this study was to implement a machine learning model to predict skin dose from targeted intraoperative (TARGIT) treatment resulting in timely adoption of strategies to limit excessive skin dose. METHODS A total of 283 patients affected by invasive breast carcinoma underwent TARGIT with a prescribed dose of 6 Gy at 1 cm, after lumpectomy. Radiochromic films were used to measure the dose to the skin for each patient. Univariate statistical analysis was performed to identify correlation of physical and patient variables with measured dose. After feature selection of predictors of in vivo skin dose, machine learning models stepwise linear regression (SLR), support vector regression (SVR), ensemble with bagging or boosting, and feed forward neural networks were trained on results of in vivo dosimetry to derive models to predict skin dose. Models were evaluated by tenfold cross validation and ranked according to root mean square error (RMSE) and adjusted correlation coefficient of true vs predicted values (adj-R2 ). RESULTS The predictors correlated with in vivo dosimetry were the distance of skin from source, depth-dose in water at depth of the applicator in the breast, use of a replacement source, and irradiation time. The best performing model was SVR, which scored RMSE and adj-R2 , equal to 0.746 [95% confidence intervals (CI), 95% CI 0.737,0.756] and 0.481 (95% CI 0.468,0.494), respectively, on the tenfold cross validation. CONCLUSION The model trained on results of in vivo dosimetry can be used to predict skin dose during setup of patient for TARGIT and this allows for timely adoption of strategies to prevent of excessive skin dose.
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Affiliation(s)
- Michele Avanzo
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Giovanni Pirrone
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Mario Mileto
- Department of Breast Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Samuele Massarut
- Department of Breast Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Joseph Stancanello
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Milad Baradaran-Ghahfarokhi
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Alexandra Rink
- Department of Radiation Physics, Princess Margaret Cancer Centre, ON, M5G 2M9, Canada
| | - Loredana Barresi
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Lorenzo Vinante
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Erica Piccoli
- Department of Breast Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
| | - Marco Trovo
- Department of Radiation Oncology, Udine General Hospital, 33100, Udine, UD, Italy
| | - Issam El Naqa
- Department of Radiation Oncology, Physics Division, University of Michigan, Ann Arbor, MI, 48103-493, USA
| | - Giovanna Sartor
- Division of Medical Physics, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081, Aviano, PN, Italy
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Meyer P, Noblet V, Mazzara C, Lallement A. Survey on deep learning for radiotherapy. Comput Biol Med 2018; 98:126-146. [PMID: 29787940 DOI: 10.1016/j.compbiomed.2018.05.018] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022]
Abstract
More than 50% of cancer patients are treated with radiotherapy, either exclusively or in combination with other methods. The planning and delivery of radiotherapy treatment is a complex process, but can now be greatly facilitated by artificial intelligence technology. Deep learning is the fastest-growing field in artificial intelligence and has been successfully used in recent years in many domains, including medicine. In this article, we first explain the concept of deep learning, addressing it in the broader context of machine learning. The most common network architectures are presented, with a more specific focus on convolutional neural networks. We then present a review of the published works on deep learning methods that can be applied to radiotherapy, which are classified into seven categories related to the patient workflow, and can provide some insights of potential future applications. We have attempted to make this paper accessible to both radiotherapy and deep learning communities, and hope that it will inspire new collaborations between these two communities to develop dedicated radiotherapy applications.
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Affiliation(s)
- Philippe Meyer
- Department of Medical Physics, Paul Strauss Center, Strasbourg, France.
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