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Choi BS, Yoo SK, Moon J, Chung SY, Oh J, Baek S, Kim Y, Chang JS, Kim H, Kim JS. Acute coronary event (ACE) prediction following breast radiotherapy by features extracted from 3D CT, dose, and cardiac structures. Med Phys 2023; 50:6409-6420. [PMID: 36974390 DOI: 10.1002/mp.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE Heart toxicity, such as major acute coronary events (ACE), following breast radiation therapy (RT) is of utmost concern. Thus, many studies have been investigating the effect of mean heart dose (MHD) and dose received in heart sub-structures on toxicity. Most studies focused on the dose thresholds in the heart and its sub-structures, while few studies adopted such computational methods as deep neural networks (DNN) and radiomics. This work aims to construct a feature-driven predictive model for ACE after breast RT. METHODS A recently proposed two-step predictive model that extracts a number of features from a deep auto-segmentation network and processes the selected features for prediction was adopted. This work refined the auto-segmenting network and feature processing algorithms to enhance performance in cardiac toxicity prediction. In the predictive model, the deep convolutional neural network (CNN) extracted features from 3D computed tomography (CT) images and dose distributions in three automatically segmented heart sub-structures, including the left anterior descending artery (LAD), right coronary artery (RCA), and left ventricle (LV). The optimal feature processing workflow for the extracted features was explored to enhance the prediction accuracy. The regions associated with toxicity were visualized using a class activation map (CAM)-based technique. Our proposed model was validated against a conventional DNN (convolutional and fully connected layers) and radiomics with a patient cohort of 84 cases, including 29 and 55 patient cases with and without ACE. Of the entire 84 cases, 12 randomly chosen cases (5 toxicity and 7 non-toxicity cases) were set aside for independent test, and the remaining 72 cases were applied to 4-fold stratified cross-validation. RESULTS Our predictive model outperformed the conventional DNN by 38% and 10% and radiomics-based predictive models by 9% and 10% in AUC for 4-fold cross-validations and independent test, respectively. The degree of enhancement was greater when incorporating dose information and heart sub-structures into feature extraction. The model whose inputs were CT, dose, and three sub-structures (LV, LAD, and RCA) reached 96% prediction accuracy on average and 0.94 area under the curve (AUC) on average in the cross-validation, and also achieved prediction accuracy of 83% and AUC of 0.83 in the independent test. On 10 correctly predicted cases out of 12 for the independent test, the activation maps implied that for cases of ACE toxicity, the higher intensity was more likely to be observed inside the LV. CONCLUSIONS The proposed model characterized by modifications in model input with dose distributions and cardiac sub-structures, and serial processing of feature extraction and feature selection techniques can improve the predictive performance in ACE following breast RT.
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Affiliation(s)
- Byong Su Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Kyun Yoo
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinyoung Moon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yeun Chung
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital, and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Stephen Baek
- School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - Yusung Kim
- Department of Radiation Physics, The Universiy of Texas MD Anderson Cancer Center, Texas, USA
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiation Oncology, Gangnam Severance Hospital, Seoul, South Korea
| | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Chamseddine I, Kim Y, De B, Naqa IE, Duda DG, Wolfgang JA, Pursley J, Wo JY, Hong TS, Paganetti H, Koay EJ, Grassberger C. Predictive Model of Liver Toxicity to Aid the Personalized Selection of Proton Versus Photon Therapy in Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)00104-9. [PMID: 36739920 DOI: 10.1016/j.ijrobp.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/23/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE Our objective was to develop an externally validated model for predicting liver toxicity after radiation therapy in patients with hepatocellular carcinoma (HCC) that can integrate both photon and proton dose distributions with patient-specific characteristics. METHODS AND MATERIALS Training data consisted of all patients with HCC treated between 2008 and 2019 at our institution (n = 117, 60%/40% photon/proton). We developed a shallow convolutional neural network (CNN) to predict posttreatment liver dysfunction from the differential dose-volume histogram (DVH) and baseline liver metrics. To reduce bias and improve robustness, we used ensemble learning (CNNE). After a preregistered study analysis plan, we evaluated stability using internal bootstrap resampling and generalizability using a data set from a different institution (n = 88). Finally, we implemented a class activation map method to characterize the critical DVH subregions and benchmarked the model against logistic regression and XGBoost. The models were evaluated using the area under the receiver operating characteristic curve and area under the precision-recall curve. RESULTS The CNNE model showed similar internal performance and robustness compared with the benchmarks. CNNE exceeded the benchmark models in external validation, with an area under the receiver operating characteristic curve of 0.78 versus 0.55 to 0.70, and an area under the precision-recall curve of 0.6 versus 0.43 to 0.52. The model showed improved predictive power in the photon group, excellent specificity in both modalities, and high sensitivity in the photon high-risk group. Models built solely on DVHs confirm outperformance of the CNNE and indicate that the proposed structure efficiently abstracts features from both proton and photon dose distributions. The activation map method demonstrates the importance of the low-dose bath and its interaction with low liver function at baseline. CONCLUSIONS We developed and externally validated a patient-specific prediction model for hepatic toxicity based on the entire DVH and clinical factors that can integrate both photon and proton therapy cohorts. This model complements the new American Society for Radiation Oncology clinical practice guidelines and could support value-driven integration of proton therapy into the management of HCC.
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Affiliation(s)
- Ibrahim Chamseddine
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Yejin Kim
- Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Brian De
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Dan G Duda
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eugene J Koay
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Elhaminia B, Gilbert A, Lilley J, Abdar M, Frangi AF, Scarsbrook A, Appelt A, Gooya A. Toxicity Prediction in Pelvic Radiotherapy Using Multiple Instance Learning and Cascaded Attention Layers. IEEE J Biomed Health Inform 2023; PP:1958-1966. [PMID: 37022057 DOI: 10.1109/jbhi.2023.3238825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Modern radiotherapy delivers treatment plans optimised on an individual patient level, using CT-based 3D models of patient anatomy. This optimisation is fundamentally based on simple assumptions about the relationship between radiation dose delivered to the cancer (increased dose will increase cancer control) and normal tissue (increased dose will increase rate of side effects). The details of these relationships are still not well understood, especially for radiation-induced toxicity. We propose a convolutional neural network based on multiple instance learning to analyse toxicity relationships for patients receiving pelvic radiotherapy. A dataset comprising of 315 patients were included in this study; with 3D dose distributions, pre-treatment CT scans with annotated abdominal structures, and patient-reported toxicity scores provided for each participant. In addition, we propose a novel mechanism for segregating the attentions over space and dose/imaging features independently for a better understanding of the anatomical distribution of toxicity. Quantitative and qualitative experiments were performed to evaluate the network performance. The proposed network could predict toxicity with 80% accuracy. Attention analysis over space demonstrated that there was a significant association between radiation dose to the anterior and right iliac of the abdomen and patient-reported toxicity. Experimental results showed that the proposed network had outstanding performance for toxicity prediction, localisation and explanation with the ability of generalisation for an unseen dataset.
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Mancosu P, Lambri N, Castiglioni I, Dei D, Iori M, Loiacono D, Russo S, Talamonti C, Villaggi E, Scorsetti M, Avanzo M. Applications of artificial intelligence in stereotactic body radiation therapy. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/04/2022] [Indexed: 11/12/2022]
Abstract
Abstract
This topical review focuses on the applications of artificial intelligence (AI) tools to stereotactic body radiation therapy (SBRT). The high dose per fraction and the limited number of fractions in SBRT require stricter accuracy than standard radiation therapy. The intent of this review is to describe the development and evaluate the possible benefit of AI tools integration into the radiation oncology workflow for SBRT automation. The selected papers were subdivided into four sections, representative of the whole radiotherapy process: ‘AI in SBRT target and organs at risk contouring’, ‘AI in SBRT planning’, ‘AI during the SBRT delivery’, and ‘AI for outcome prediction after SBRT’. Each section summarises the challenges, as well as limits and needs for improvement to achieve better integration of AI tools in the clinical workflow.
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A Survey on Deep Learning for Precision Oncology. Diagnostics (Basel) 2022; 12:diagnostics12061489. [PMID: 35741298 PMCID: PMC9222056 DOI: 10.3390/diagnostics12061489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 12/27/2022] Open
Abstract
Precision oncology, which ensures optimized cancer treatment tailored to the unique biology of a patient’s disease, has rapidly developed and is of great clinical importance. Deep learning has become the main method for precision oncology. This paper summarizes the recent deep-learning approaches relevant to precision oncology and reviews over 150 articles within the last six years. First, we survey the deep-learning approaches categorized by various precision oncology tasks, including the estimation of dose distribution for treatment planning, survival analysis and risk estimation after treatment, prediction of treatment response, and patient selection for treatment planning. Secondly, we provide an overview of the studies per anatomical area, including the brain, bladder, breast, bone, cervix, esophagus, gastric, head and neck, kidneys, liver, lung, pancreas, pelvis, prostate, and rectum. Finally, we highlight the challenges and discuss potential solutions for future research directions.
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A Design of CGK-Based Granular Model Using Hierarchical Structure. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12063154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In this paper, we propose context-based GK clustering and design a CGK-based granular model and a hierarchical CGK-based granular model. Existing fuzzy clustering generates clusters using Euclidean distances. However, there is a problem in that performance decreases when a cluster is created from data with strong nonlinearity. To improve this problem, GK clustering is used. GK clustering creates clusters using Mahalanobis distance. In this paper, we propose context-based GK (CGK) clustering, which adds a method that considers the output space in the existing GK clustering, to create a cluster that considers not only the input space but also the output space. there is. Based on the proposed CGK clustering, a CGK-based granular model and a hierarchical CGK-based granular model were designed. Since the output of the CGK-based granular model is in the form of a context, it has the advantage of verbally expressing the prediction result, and the CGK-based granular model with a hierarchical structure can generate high-dimensional information granules, so meaningful information with high abstraction value granules can be created. In order to verify the validity of the method proposed in this paper, as a result of conducting an experiment using the concrete compressive strength database, it was confirmed that the proposed methods showed superior performance than the existing granular models.
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Appelt AL, Elhaminia B, Gooya A, Gilbert A, Nix M. Deep Learning for Radiotherapy Outcome Prediction Using Dose Data - A Review. Clin Oncol (R Coll Radiol) 2022; 34:e87-e96. [PMID: 34924256 DOI: 10.1016/j.clon.2021.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 12/23/2022]
Abstract
Artificial intelligence, and in particular deep learning using convolutional neural networks, has been used extensively for image classification and segmentation, including on medical images for diagnosis and prognosis prediction. Use in radiotherapy prognostic modelling is still limited, however, especially as applied to toxicity and tumour response prediction from radiation dose distributions. We review and summarise studies that applied deep learning to radiotherapy dose data, in particular studies that utilised full three-dimensional dose distributions. Ten papers have reported on deep learning models for outcome prediction utilising spatial dose information, whereas four studies used reduced dimensionality (dose volume histogram) information for prediction. Many of these studies suffer from the same issues that plagued early normal tissue complication probability modelling, including small, single-institutional patient cohorts, lack of external validation, poor data and model reporting, use of late toxicity data without taking time-to-event into account, and nearly exclusive focus on clinician-reported complications. They demonstrate, however, how radiation dose, imaging and clinical data may be technically integrated in convolutional neural networks-based models; and some studies explore how deep learning may help better understand spatial variation in radiosensitivity. In general, there are a number of issues specific to the intersection of radiotherapy outcome modelling and deep learning, for example translation of model developments into treatment plan optimisation, which will require further combined effort from the radiation oncology and artificial intelligence communities.
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Affiliation(s)
- A L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
| | - B Elhaminia
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - A Gooya
- Centre for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), Department of Electronic and Electrical Engineering, University of Leeds, Leeds, UK
| | - A Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - M Nix
- Department of Medical Physics and Engineering, Leeds Cancer Centre, St James's University Hospital, Leeds, UK
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Chamseddine I, Kim Y, De B, El Naqa I, Duda DG, Wolfgang J, Pursley J, Paganetti H, Wo J, Hong T, Koay EJ, Grassberger C. Predictive Modeling of Survival and Toxicity in Patients With Hepatocellular Carcinoma After Radiotherapy. JCO Clin Cancer Inform 2022; 6:e2100169. [PMID: 35192402 PMCID: PMC8863122 DOI: 10.1200/cci.21.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/20/2021] [Accepted: 01/06/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To stratify patients and aid clinical decision making, we developed machine learning models to predict treatment failure and radiation-induced toxicities after radiotherapy (RT) in patients with hepatocellular carcinoma across institutions. MATERIALS AND METHODS The models were developed using linear and nonlinear algorithms, predicting survival, nonlocal failure, radiation-induced liver disease, and lymphopenia from baseline patient and treatment parameters. The models were trained on 207 patients from Massachusetts General Hospital. Performance was quantified using Harrell's c-index, area under the curve (AUC), and accuracy in high-risk populations. Models' structures were optimized in a nested cross-validation approach to prevent overfitting. A study analysis plan was registered before external validation using 143 patients from MD Anderson Cancer Center. Clinical utility was assessed using net-benefit analysis. RESULTS The survival model stratified high-risk versus low-risk patients well in the external validation cohort (c-index = 0.75), better than existing risk scores. Predictions of 1-year survival and nonlocal failure were excellent (external AUC = 0.74 and 0.80, respectively), especially in the high-risk group (accuracy > 90%). Cause-of-death analysis showed differential modes of treatment failure in these cohorts and indicated that these models could be used to stratify RT patients for liver-sparing treatment regimen or combination approaches with systemic agents. Predictions of liver disease and lymphopenia were good but less robust (external AUC = 0.68 and 0.7, respectively), suggesting the need for more comprehensive consideration of dosimetry and better predictive biomarkers. The liver disease model showed excellent accuracy in the high-risk group (92%) and revealed possible interactions of platelet count with initial liver function. CONCLUSION Machine learning approaches can provide reliable outcome predictions in patients with hepatocellular carcinoma after RT in diverse cohorts across institutions. The excellent performance, particularly in high-risk patients, suggests novel strategies for patient stratification and treatment selection.
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Affiliation(s)
- Ibrahim Chamseddine
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yejin Kim
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Brian De
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Issam El Naqa
- Department of Machine Learning, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Dan G. Duda
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Theodore Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Eugene J. Koay
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Padmakala S, Subasini CA, Karuppiah SP, Sheeba A. ESVM-SWRF: Ensemble SVM-based sample weighted random forests for liver disease classification. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3525. [PMID: 34431606 DOI: 10.1002/cnm.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Recently, a significant way to diagnose the disease is using the model of medical data mining. The most challenging task in the healthcare field is to face a large amount of data during disease analyzes and prediction. Once the data are transformed into valuable data by means of data mining models then the actual prediction and decision making is easier. The existing studies met few shortcomings because of higher execution time, more computational complexities, less scalability, slow convergence, and lack of providing the solution. In this article, we have proposed an ensemble SVM-based sample weighted random forests (eSVM-swRF) with novel improved colliding body optimization (NICBO) algorithm to predict liver diseases. The extraction, loading, transformation, and analysis (ELTA) are used to pre-process the patient data. The significant feature with a suitable model is generated depending upon the filter-based method. Based on eSVM-swRF, the parameter values such as penalty parameter (P), threshold (T), and mTry are optimized via a novel improved colliding boding optimization (NICBO) algorithm. The UCI dataset provides liver disease data for this study. The implementation platform of RapidMiner Studio version 7.6 with different evaluation measures is used to validate the performance of eSVM-swRF with the NICBO method. Anyway, the proposed method yields outstanding performance than other existing methods such as Particle Swarm Optimization-based Support Vector Machine (PSO-SVM), fuzzy adaptive, and neighbor weighted k-NN (FuzzyANWKNN), Naïve Bayes-based Support Vector Machine (NB-SVM), and Neural network.
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Affiliation(s)
- S Padmakala
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
| | - C A Subasini
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
| | - S P Karuppiah
- Departmentof MBA, St. Joseph's College of Engineering, Chennai, India
| | - Adlin Sheeba
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
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Zhou J, Yang X, Chang CW, Tian S, Wang T, Lin L, Wang Y, Janopaul-Naylor JR, Patel P, Demoor JD, Bohannon D, Stanforth A, Eaton B, McDonald MW, Liu T, Patel SA. Dosimetric Uncertainties in Dominant Intraprostatic Lesion Simultaneous Boost Using Intensity Modulated Proton Therapy. Adv Radiat Oncol 2021; 7:100826. [PMID: 34805623 PMCID: PMC8581277 DOI: 10.1016/j.adro.2021.100826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose While intensity modulated proton therapy can deliver simultaneous integrated boost (SIB) to the dominant intraprostatic lesion (DIL) with high precision, it is sensitive to anatomic changes. We investigated the dosimetric effects from these changes based on pretreatment cone-beam computed tomographic (CBCT) images and identified the most important factors using a multilayer perceptron neural network (MLPNN). Methods and Materials DILs were contoured based on coregistered multiparametric magnetic resonance images for 25 previously treated prostate cancer patients. SIB plans were created with (1) prostate clinical target volume − V70 Gy = 98%; (2) DIL − V98 Gy > 95%; and (3) all organs at risk (OARs)"?> within clinical constraints. SIB plans were applied to daily CBCT-based deformed planning computed tomography (CT)"?>. DIL − V98 Gy, bladder/rectum maximum dose (Dmax) and volume changes, femur shifts, and the distance from DIL to organs at riskOARs"?> in both planning computed tomogramsCT"?> and CBCT were calculated. Wilcoxon signed-ranks tests were used to compare the changes. MLPNNs were used to model the change in ΔDIL − V98 Gy > 10% and bladder/rectum Dmax > 80 Gy, and the relative importance factors for the model were provided. The performances of the models were evaluated with receiver operating characteristic curves. Results Comparing initial plan to the average from evaluation plans, respectively, DIL − V98 Gy was 89.3% ± 19.9% versus 86.2% ± 21.3% (P = .151); bladder Dmax 71.9 ± 0.6 Gy versus 74.5 ± 2.9 Gy (P < .001); and rectum Dmax 70.1 ± 2.4 Gy versus 74.9 ± 9.1Gy (P = .007). Bladder and rectal volumes were 99.6% ± 39.5% and 112.8% ± 27.2%, respectively, of their initial volume. The femur shift was 3.16 ± 2.52 mm. In the modeling of ΔDIL V98 Gy > 10%, DIL to rectum distance changes, DIL to bladder distance changes, and rectum volume changes ratio are the 3 most important factors. The areas under the receiver operating characteristic curves were 0.89, 1.00, and 0.99 for the modeling of ΔDIL − V98 Gy > 10%, and bladder and rectum Dmax > 80 Gy, respectively. Conclusions Dosimetric changes in DIL SIB with intensity modulated proton therapy can be modeled and classified based on anatomic changes on pretreatment images by an MLPNN.
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Affiliation(s)
- Jun Zhou
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Chih-Wei Chang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Sibo Tian
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Tonghe Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Yinan Wang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Pretesh Patel
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - John D Demoor
- Department of Medical Physics, Georgia Institute of Technology, Atlanta, Georgia
| | - Duncan Bohannon
- Department of Medical Physics, Georgia Institute of Technology, Atlanta, Georgia
| | - Alex Stanforth
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Bree Eaton
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Tian Liu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Sagar Anil Patel
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
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Ebert MA, Gulliford S, Acosta O, de Crevoisier R, McNutt T, Heemsbergen WD, Witte M, Palma G, Rancati T, Fiorino C. Spatial descriptions of radiotherapy dose: normal tissue complication models and statistical associations. Phys Med Biol 2021; 66:12TR01. [PMID: 34049304 DOI: 10.1088/1361-6560/ac0681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022]
Abstract
For decades, dose-volume information for segmented anatomy has provided the essential data for correlating radiotherapy dosimetry with treatment-induced complications. Dose-volume information has formed the basis for modelling those associations via normal tissue complication probability (NTCP) models and for driving treatment planning. Limitations to this approach have been identified. Many studies have emerged demonstrating that the incorporation of information describing the spatial nature of the dose distribution, and potentially its correlation with anatomy, can provide more robust associations with toxicity and seed more general NTCP models. Such approaches are culminating in the application of computationally intensive processes such as machine learning and the application of neural networks. The opportunities these approaches have for individualising treatment, predicting toxicity and expanding the solution space for radiation therapy are substantial and have clearly widespread and disruptive potential. Impediments to reaching that potential include issues associated with data collection, model generalisation and validation. This review examines the role of spatial models of complication and summarises relevant published studies. Sources of data for these studies, appropriate statistical methodology frameworks for processing spatial dose information and extracting relevant features are described. Spatial complication modelling is consolidated as a pathway to guiding future developments towards effective, complication-free radiotherapy treatment.
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Affiliation(s)
- Martin A Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- 5D Clinics, Claremont, Western Australia, Australia
| | - Sarah Gulliford
- Department of Radiotherapy Physics, University College Hospitals London, United Kingdom
- Department of Medical Physics and Bioengineering, University College London, United Kingdom
| | - Oscar Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, F-35000 Rennes, France
| | | | - Todd McNutt
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Marnix Witte
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Lang Q, Zhong C, Liang Z, Zhang Y, Wu B, Xu F, Cong L, Wu S, Tian Y. Six application scenarios of artificial intelligence in the precise diagnosis and treatment of liver cancer. Artif Intell Rev 2021. [DOI: 10.1007/s10462-021-10023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Veiga C, Lim P, Anaya VM, Chandy E, Ahmad R, D'Souza D, Gaze M, Moinuddin S, Gains J. Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer. Phys Med Biol 2021; 66. [PMID: 33735848 PMCID: PMC8112163 DOI: 10.1088/1361-6560/abf010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/18/2021] [Indexed: 11/12/2022]
Abstract
Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Pei Lim
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginia Marin Anaya
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Edward Chandy
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
| | - Reem Ahmad
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Derek D'Souza
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Gaze
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jennifer Gains
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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Paganetti H, Beltran C, Both S, Dong L, Flanz J, Furutani K, Grassberger C, Grosshans DR, Knopf AC, Langendijk JA, Nystrom H, Parodi K, Raaymakers BW, Richter C, Sawakuchi GO, Schippers M, Shaitelman SF, Teo BKK, Unkelbach J, Wohlfahrt P, Lomax T. Roadmap: proton therapy physics and biology. Phys Med Biol 2021; 66. [DOI: 10.1088/1361-6560/abcd16] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
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16
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Cherezov D, Paul R, Fetisov N, Gillies RJ, Schabath MB, Goldgof DB, Hall LO. Lung Nodule Sizes Are Encoded When Scaling CT Image for CNN's. ACTA ACUST UNITED AC 2020; 6:209-215. [PMID: 32548298 PMCID: PMC7289250 DOI: 10.18383/j.tom.2019.00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Noninvasive diagnosis of lung cancer in early stages is one task where radiomics helps. Clinical practice shows that the size of a nodule has high predictive power for malignancy. In the literature, convolutional neural networks (CNNs) have become widely used in medical image analysis. We study the ability of a CNN to capture nodule size in computed tomography images after images are resized for CNN input. For our experiments, we used the National Lung Screening Trial data set. Nodules were labeled into 2 categories (small/large) based on the original size of a nodule. After all extracted patches were re-sampled into 100-by-100-pixel images, a CNN was able to successfully classify test nodules into small- and large-size groups with high accuracy. To show the generality of our discovery, we repeated size classification experiments using Common Objects in Context (COCO) data set. From the data set, we selected 3 categories of images, namely, bears, cats, and dogs. For all 3 categories a 5- × 2-fold cross-validation was performed to put them into small and large classes. The average area under receiver operating curve is 0.954, 0.952, and 0.979 for the bear, cat, and dog categories, respectively. Thus, camera image rescaling also enables a CNN to discover the size of an object. The source code for experiments with the COCO data set is publicly available in Github (https://github.com/VisionAI-USF/COCO_Size_Decoding/).
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Affiliation(s)
- Dmitry Cherezov
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL
| | - Rahul Paul
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL
| | - Nikolai Fetisov
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL
| | | | - Matthew B Schabath
- Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Dmitry B Goldgof
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL
| | - Lawrence O Hall
- Department of Computer Sciences and Engineering, University of South Florida, Tampa, FL
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Ibragimov B, Toesca DAS, Chang DT, Yuan Y, Koong AC, Xing L, Vogelius IR. Deep learning for identification of critical regions associated with toxicities after liver stereotactic body radiation therapy. Med Phys 2020; 47:3721-3731. [DOI: 10.1002/mp.14235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 05/05/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Bulat Ibragimov
- Department of Computer Science University of Copenhagen Copenhagen Denmark
| | - Diego A. S. Toesca
- Department of Radiation Oncology Stanford University School of Medicine Stanford CA USA
| | - Daniel T. Chang
- Department of Radiation Oncology Stanford University School of Medicine Stanford CA USA
| | - Yixuan Yuan
- Department of Electronic Engineering City University of Hong Kong Hong Kong
| | - Albert C. Koong
- Department of Radiation Oncology MD Anderson Cancer Center Houston Texas
| | - Lei Xing
- Department of Radiation Oncology Stanford University School of Medicine Stanford CA USA
| | - Ivan R. Vogelius
- Department of Oncology Faulty of Health & Medical Sciences Rigshospitalet University of Copenhagen Copenhagen Denmark
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Wang R, Weng Y, Zhou Z, Chen L, Hao H, Wang J. Multi-objective ensemble deep learning using electronic health records to predict outcomes after lung cancer radiotherapy. Phys Med Biol 2019; 64:245005. [PMID: 31698346 DOI: 10.1088/1361-6560/ab555e] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Accurately predicting treatment outcome is crucial for creating personalized treatment plans and follow-up schedules. Electronic health records (EHRs) contain valuable patient-specific information that can be leveraged to improve outcome prediction. We propose a reliable multi-objective ensemble deep learning (MoEDL) method that uses features extracted from EHRs to predict high risk of treatment failure after radiotherapy in patients with lung cancer. The dataset used in this study contains EHRs of 814 patients who had not achieved disease-free status and 193 patients who were disease-free with at least one year follow-up time after lung cancer radiation therapy. The proposed MoEDL consists of three phases: (1) training with dynamic ensemble deep learning; (2) model selection with adaptive multi-objective optimization; and (3) testing with evidential reasoning (ER) fusion. Specifically, in the training phase, we employ deep perceptron networks as base learners to handle various issues with EHR data. The architecture and key hyper-parameters of each base learner are dynamically adjusted to increase the diversity of learners while reducing the time spent tuning hyper-parameters. Furthermore, we integrate the snapshot ensembles (SE) restarting strategy, multi-objective optimization, and ER fusion to improve the prediction robustness and accuracy of individual networks. The SE restarting strategy can yield multiple candidate models at no additional training cost in the training stage. The multi-objective model simultaneously considers sensitivity, specificity, and AUC as objective functions, overcoming the limitations of single-objective-based model selection. For the testing stage, we utilized an analytic ER rule to fuse the output scores from each optimal model to obtain reliable and robust predictive results. Our experimental results demonstrate that MoEDL can perform better than other conventional methods.
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Affiliation(s)
- Rongfang Wang
- School of Artificial Intelligence, Xidian University, Xi'an 710071, People's Republic of China. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States of America. Medical Artificial Intelligence and Automation (MAIA) Lab, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States of America
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