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Artificial Intelligence for Outcome Modeling in Radiotherapy. Semin Radiat Oncol 2022; 32:351-364. [DOI: 10.1016/j.semradonc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Luo Y, Jolly S, Palma D, Lawrence TS, Tseng HH, Valdes G, McShan D, Ten Haken RK, Ei Naqa I. A situational awareness Bayesian network approach for accurate and credible personalized adaptive radiotherapy outcomes prediction in lung cancer patients. Phys Med 2021; 87:11-23. [PMID: 34091197 DOI: 10.1016/j.ejmp.2021.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A situational awareness Bayesian network (SA-BN) approach is developed to improve physicians' trust in the prediction of radiation outcomes and evaluate its performance for personalized adaptive radiotherapy (pART). METHODS 118 non-small-cell lung cancer patients with their biophysical features were employed for discovery (n = 68) and validation (n = 50) of radiation outcomes prediction modeling. Patients' important characteristics identified by radiation experts to predict individual's tumor local control (LC) or radiation pneumonitis with grade ≥ 2 (RP2) were incorporated as expert knowledge (EK). Besides generating an EK-based naïve BN (EK-NBN), an SA-BN was developed by incorporating the EK features into pure data-driven BN (PD-BN) methods to improve the credibility of LC or / and RP2 prediction. After using area under the free-response receiver operating characteristics curve (AU-FROC) to assess the joint prediction of these outcomes, their prediction performances were compared with a regression approach based on the expert yielded estimates (EYE) penalty and its variants. RESULTS In addition to improving the credibility of radiation outcomes prediction, the SA-BN approach outperformed the EYE penalty and its variants in terms of the joint prediction of LC and RP2. The value of AU-FROC improves from 0.70 (95% CI: 0.54-0.76) using EK-NBN, to 0.75 (0.65-0.82) using a variant of EYE penalty, to 0.83 (0.75-0.93) using PD-BN and 0.83 (0.77-0.90) using SA-BN; with similar trends in the validation cohort. CONCLUSIONS The SA-BN approach can provide an accurate and credible human-machine interface to gain physicians' trust in clinical decision-making, which has the potential to be an important component of pART.
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Affiliation(s)
- Yi Luo
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA.
| | - Shruti Jolly
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - David Palma
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Theodore S Lawrence
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Huan-Hsin Tseng
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Gilmer Valdes
- Department of Radiation Oncology, UCSF Medical Center at Mission Bay, San Francisco, CA, USA
| | - Daniel McShan
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Randall K Ten Haken
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Issam Ei Naqa
- Department of Radiation Oncology, The University of Michigan, Ann Arbor, MI, USA
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Chen Z, Zeng DD, Seltzer RGN, Hamilton BD. Automated Generation of Personalized Shock Wave Lithotripsy Protocols: Treatment Planning Using Deep Learning. JMIR Med Inform 2021; 9:e24721. [PMID: 33973862 PMCID: PMC8150413 DOI: 10.2196/24721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/31/2020] [Accepted: 04/11/2021] [Indexed: 12/23/2022] Open
Abstract
Background Though shock wave lithotripsy (SWL) has developed to be one of the most common treatment approaches for nephrolithiasis in recent decades, its treatment planning is often a trial-and-error process based on physicians’ subjective judgement. Physicians’ inexperience with this modality can lead to low-quality treatment and unnecessary risks to patients. Objective To improve the quality and consistency of shock wave lithotripsy treatment, we aimed to develop a deep learning model for generating the next treatment step by previous steps and preoperative patient characteristics and to produce personalized SWL treatment plans in a step-by-step protocol based on the deep learning model. Methods We developed a deep learning model to generate the optimal power level, shock rate, and number of shocks in the next step, given previous treatment steps encoded by long short-term memory neural networks and preoperative patient characteristics. We constructed a next-step data set (N=8583) from top practices of renal SWL treatments recorded in the International Stone Registry. Then, we trained the deep learning model and baseline models (linear regression, logistic regression, random forest, and support vector machine) with 90% of the samples and validated them with the remaining samples. Results The deep learning models for generating the next treatment steps outperformed the baseline models (accuracy = 98.8%, F1 = 98.0% for power levels; accuracy = 98.1%, F1 = 96.0% for shock rates; root mean squared error = 207, mean absolute error = 121 for numbers of shocks). The hypothesis testing showed no significant difference between steps generated by our model and the top practices (P=.480 for power levels; P=.782 for shock rates; P=.727 for numbers of shocks). Conclusions The high performance of our deep learning approach shows its treatment planning capability on par with top physicians. To the best of our knowledge, our framework is the first effort to implement automated planning of SWL treatment via deep learning. It is a promising technique in assisting treatment planning and physician training at low cost.
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Affiliation(s)
- Zhipeng Chen
- Shenzhen Artificial Intelligence and Data Science Institute (Longhua), Longhua, Shenzhen, China
| | - Daniel D Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ryan G N Seltzer
- Translational Analytics and Statistics, Tucson, AZ, United States
| | - Blake D Hamilton
- School of Medicine, University of Utah, Salt Lake City, UT, United States
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Luo Y, Chen S, Valdes G. Machine learning for radiation outcome modeling and prediction. Med Phys 2020; 47:e178-e184. [DOI: 10.1002/mp.13570] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Yi Luo
- Department of Radiation Oncology University of Michigan Ann Arbor MI 48103USA
| | - Shifeng Chen
- Department of Radiation Oncology University of Maryland School of Medicine Baltimore MD 21201USA
| | - Gilmer Valdes
- Department of Radiation Oncology University of California San Francisco CA 94158USA
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Decision Support Systems in Prostate Cancer Treatment: An Overview. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4961768. [PMID: 31281840 PMCID: PMC6590598 DOI: 10.1155/2019/4961768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/02/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
Background A multifactorial decision support system (mDSS) is a tool designed to improve the clinical decision-making process, while using clinical inputs for an individual patient to generate case-specific advice. The study provides an overview of the literature to analyze current available mDSS focused on prostate cancer (PCa), in order to better understand the availability of decision support tools as well as where the current literature is lacking. Methods We performed a MEDLINE literature search in July 2018. We divided the included studies into different sections: diagnostic, which aids in detection or staging of PCa; treatment, supporting the decision between treatment modalities; and patient, which focusses on informing the patient. We manually screened and excluded studies that did not contain an mDSS concerning prostate cancer and study proposals. Results Our search resulted in twelve diagnostic mDSS; six treatment mDSS; two patient mDSS; and eight papers that could improve mDSS. Conclusions Diagnosis mDSS is well represented in the literature as well as treatment mDSS considering external-beam radiotherapy; however, there is a lack of mDSS for other treatment modalities. The development of patient decision aids is a new field of research, and few successes have been made for PCa patients. These tools can improve personalized medicine but need to overcome a number of difficulties to be successful and require more research.
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Hussein M, Heijmen BJM, Verellen D, Nisbet A. Automation in intensity modulated radiotherapy treatment planning-a review of recent innovations. Br J Radiol 2018; 91:20180270. [PMID: 30074813 DOI: 10.1259/bjr.20180270] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy treatment planning of complex radiotherapy techniques, such as intensity modulated radiotherapy and volumetric modulated arc therapy, is a resource-intensive process requiring a high level of treatment planner intervention to ensure high plan quality. This can lead to variability in the quality of treatment plans and the efficiency in which plans are produced, depending on the skills and experience of the operator and available planning time. Within the last few years, there has been significant progress in the research and development of intensity modulated radiotherapy treatment planning approaches with automation support, with most commercial manufacturers now offering some form of solution. There is a rapidly growing number of research articles published in the scientific literature on the topic. This paper critically reviews the body of publications up to April 2018. The review describes the different types of automation algorithms, including the advantages and current limitations. Also included is a discussion on the potential issues with routine clinical implementation of such software, and highlights areas for future research.
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Affiliation(s)
- Mohammad Hussein
- 1 Metrology for Medical Physics Centre, National Physical Laboratory , Teddington , UK
| | - Ben J M Heijmen
- 2 Division of Medical Physics, Erasmus MC Cancer Institute , Rotterdam , The Netherlands
| | - Dirk Verellen
- 3 Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB) , Brussels , Belgium.,4 Radiotherapy Department, Iridium Kankernetwerk , Antwerp , Belgium
| | - Andrew Nisbet
- 5 Department of Medical Physics, Royal Surrey County Hospital NHS Foundation Trust , Guildford , UK.,6 Department of Physics, University of Surrey , Guildford , UK
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El Naqa I, Ruan D, Valdes G, Dekker A, McNutt T, Ge Y, Wu QJ, Oh JH, Thor M, Smith W, Rao A, Fuller C, Xiao Y, Manion F, Schipper M, Mayo C, Moran JM, Ten Haken R. Machine learning and modeling: Data, validation, communication challenges. Med Phys 2018; 45:e834-e840. [PMID: 30144098 DOI: 10.1002/mp.12811] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/28/2017] [Accepted: 01/22/2018] [Indexed: 11/06/2022] Open
Abstract
With the era of big data, the utilization of machine learning algorithms in radiation oncology is rapidly growing with applications including: treatment response modeling, treatment planning, contouring, organ segmentation, image-guidance, motion tracking, quality assurance, and more. Despite this interest, practical clinical implementation of machine learning as part of the day-to-day clinical operations is still lagging. The aim of this white paper is to further promote progress in this new field of machine learning in radiation oncology by highlighting its untapped advantages and potentials for clinical advancement, while also presenting current challenges and open questions for future research. The targeted audience of this paper includes newcomers as well as practitioners in the field of medical physics/radiation oncology. The paper also provides general recommendations to avoid common pitfalls when applying these powerful data analytic tools to medical physics and radiation oncology problems and suggests some guidelines for transparent and informative reporting of machine learning results.
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Affiliation(s)
- Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California Los San Francisco, San Francisco, CA, USA
| | - Andre Dekker
- GROW-School for Oncology and Developmental Biology, Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Todd McNutt
- Department of Radiation Oncology, John Hopkins University, Baltimore, MD, USA
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina, Charlotte, NC, USA
| | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wade Smith
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Arvind Rao
- Department of Radiation Oncology, MD Anderson, Houston, TX, USA.,Department of Bioinformatics and Computational Biology, MD Anderson, Houston, TX, USA
| | - Clifton Fuller
- Department of Radiation Oncology, MD Anderson, Houston, TX, USA
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Frank Manion
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Randall Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
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Smith WP, Richard PJ, Zeng J, Apisarnthanarax S, Rengan R, Phillips MH. Decision analytic modeling for the economic analysis of proton radiotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2018; 7:122-133. [PMID: 29876311 DOI: 10.21037/tlcr.2018.03.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Although proton radiation treatments are more costly than photon/X-ray therapy, they may lower overall treatment costs through reducing rates of severe toxicities and the costly management of those toxicities. To study this issue, we created a decision-model comparing proton vs. X-ray radiotherapy for locally advanced non-small cell lung cancer patients. Methods An influence diagram was created to model for radiation delivery, associated 6-month pneumonitis/esophagitis rates, and overall costs (radiation plus toxicity costs). Pneumonitis (age, chemo type, V20, MLD) and esophagitis (V60) predictors were modeled to impact toxicity rates. We performed toxicity-adjusted, rate-adjusted, risk group-adjusted, and radiosensitivity analyses. Results Upfront proton treatment costs exceeded that of photons [$16,730.37 (3DCRT), $23,893.83 (IMRT), $41,061.80 (protons)]. Based upon expected population pneumonitis and esophagitis rates for each modality, protons would be expected to recover $1,065.62 and $1,139.63 of the cost difference compared to 3DCRT or IMRT. For patients treated with IMRT experiencing grade 4 pneumonitis or grade 4 esophagitis, costs exceeded patients treated with protons without this toxicity. 3DCRT patients with grade 4 esophagitis had higher costs than proton patients without this toxicity. For the risk group analysis, high risk patients (age >65, carboplatin/paclitaxel) benefited more from proton therapy. A biomarker may allow patient selection for proton therapy, although the AUC alone is not sufficient to determine if the biomarker is clinically useful. Conclusions The comparison between proton and photon/X-ray radiation therapy for NSCLC needs to consider both the up-front cost of treatment and the possible long term cost of complications. In our analysis, current costs favor X-ray therapy. However, relatively small reductions in the cost of proton therapy may result in a shift to the preference for proton therapy.
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Affiliation(s)
- Wade P Smith
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Patrick J Richard
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Smith Apisarnthanarax
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mark H Phillips
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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Rønde HS, Wee L, Pløen J, Appelt AL. Feasibility of preference-driven radiotherapy dose treatment planning to support shared decision making in anal cancer. Acta Oncol 2017; 56:1277-1285. [PMID: 28447539 DOI: 10.1080/0284186x.2017.1315174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE/OBJECTIVE Chemo-radiotherapy is an established primary curative treatment for anal cancer, but clinically equal rationale for different target doses exists. If joint preferences (physician and patient) are used to determine acceptable tradeoffs in radiotherapy treatment planning, multiple dose plans must be simultaneously explored. We quantified the degree to which different toxicity priorities might be incorporated into treatment plan selection, to elucidate the feasible decision space for shared decision making in anal cancer radiotherapy. MATERIAL AND METHODS Retrospective plans were generated for 22 anal cancer patients. Multi-criteria optimization handles dynamically changing priorities between clinical objectives while meeting fixed clinical constraints. Four unique dose distributions were designed to represent a wide span of clinically relevant objectives: high-dose preference (60.2 Gy tumor boost and 50.4 Gy to elective nodes with physician-defined order of priorities), low-dose preference (53.75 Gy tumor boost, 45 Gy to elective nodes, physician-defined priorities), bowel sparing preference (lower dose levels and priority for bowel avoidance) and bladder sparing preference (lower dose levels and priority for bladder avoidance). RESULTS Plans satisfied constraints for target coverage. A senior oncologist approved a random subset of plans for quality assurance. Compared to a high-dose preference, bowel sparing was clinically meaningful at the lower prescribed dose [median change in V45Gy: 234 cm3; inter-quartile range (66; 247); p < .01] and for a bowel sparing preference [median change in V45Gy: 281 cm3; (73; 488); p < .01]. Compared to a high-dose preference, bladder sparing was clinically meaningful at the lower prescribed dose [median change in V35Gy: 13.7%-points; (0.3; 30.6); p < .01] and for a bladder sparing preference [median change in V35Gy: 30.3%-points; (12.4; 43.1); p < .01]. CONCLUSIONS There is decision space available in anal cancer radiotherapy to incorporate preferences, although tradeoffs are highly patient-dependent. This study demonstrates that preference-informed dose planning is feasible for clinical studies utilizing shared decision making.
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Affiliation(s)
- Heidi S. Rønde
- Department of Medical Physics, Vejle Hospital, Vejle, Denmark
| | - Leonard Wee
- MAASTRO Clinic, School of Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Danish Colorectal Cancer Centre South, Vejle Hospital, and Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - John Pløen
- Danish Colorectal Cancer Centre South, Vejle Hospital, and Institute of Regional Health Research, University of Southern Denmark, Denmark
- Department of Oncology, Vejle Hospital, Vejle, Denmark
| | - Ane L. Appelt
- Danish Colorectal Cancer Centre South, Vejle Hospital, and Institute of Regional Health Research, University of Southern Denmark, Denmark
- Leeds Institute of Cancer and Pathology, University of Leeds, and Leeds Cancer Centre, St. James' University Hospital, Leeds, UK
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Kalet AM, Doctor JN, Gennari JH, Phillips MH. Developing Bayesian networks from a dependency‐layered ontology: A proof‐of‐concept in radiation oncology. Med Phys 2017; 44:4350-4359. [DOI: 10.1002/mp.12340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alan M. Kalet
- Department of Radiation Oncology University of Washington Medical Center Seattle WAUSA
| | - Jason N. Doctor
- Department of Pharmaceutical and Health Economics University of Southern California Los Angeles CAUSA
| | - John H. Gennari
- Department of Biomedical Informatics and Medical Education University of Washington Seattle WAUSA
| | - Mark H. Phillips
- Department of Biomedical Informatics and Medical Education University of Washington Seattle WAUSA
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