Prospective study of artificial intelligence-based decision support to improve head and neck radiotherapy plan quality.
Prospective study of artificial intelligence-based decision support to improve head and neck radiotherapy plan quality.
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DOI：
10.1016/j.ctro.2021.05.006
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发表时间：
2021-07
影响因子：
3.1
通讯作者：
Lin MH
中科院分区：
文献类型：
--
作者：
Sher DJ;Godley A;Park Y;Carpenter C;Nash M;Hesami H;Zhong X;Lin MH
H&N放射治疗计划指令通常不是针对患者的。针对患者的指令可能有助于实现最佳剂量分布。使用人工智能引导的工具显著提高了几乎所有桨的实现剂量。头颈部肿瘤的体积调节弧疗(VMAT)计划是一个复杂的过程。虽然每个危险器官(OAR)可实现的最低剂量是先验未知的，但人工智能(AI)有望成为准确估计桨的预期剂量分布的工具。我们前瞻性地研究了将基于人工智能的决策支持工具(DST)整合到临床工作流程中以改善OAR备用的好处。DST剂量预测模型基于276个机构VMAT计划。在IRB批准的前瞻性试验中，医生首先为50名连续的患者生成了定制的OAR指令(医生指令，PD)。DST然后估计了OAR剂量(AI指令，AD)。对于每个OAR，治疗医生使用较低的指令来形成混合指令(HD)。最后的计划指标与每个指令进行了比较。3格雷(Gray)的剂量差被认为具有临床意义。与AD和PD相比，HD在22%至75%的病例中将OAR剂量目标降低了3Gy以上，具体取决于OAR。由此产生的临床计划通常满足这些较低的限制，并实现了平均剂量减少，比PD减少4.3到16 GY，仅比AD减少5.6到9.1GY。对于大多数桨，使用HD获得的剂量度量明显好于机构历史计划，对于所有桨，NRG约束明显好于机构历史计划。DST促进了针对这一普遍的H&N患者队列的所有桨的显著改善的治疗指令，AD和PD本身都不足以最佳地指导计划。
H&N radiation treatment plan directives are typically not patient-specific. Patient-specific directives may facilitate the best-achievable dose distribution. Use of an AI-guided tool significantly improved achieved dose for nearly all OARs. Volumetric modulated arc therapy (VMAT) planning for head and neck cancer is a complex process. While the lowest achievable dose for each individual organ-at-risk (OAR) is unknown a priori, artificial intelligence (AI) holds promise as a tool to accurately estimate the expected dose distribution for OARs. We prospectively investigated the benefits of incorporating an AI-based decision support tool (DST) into the clinical workflow to improve OAR sparing. The DST dose prediction model was based on 276 institutional VMAT plans. Under an IRB-approved prospective trial, the physician first generated a custom OAR directive for 50 consecutive patients (physician directive, PD). The DST then estimated OAR doses (AI directive, AD). For each OAR, the treating physician used the lower directive to form a hybrid directive (HD). The final plan metrics were compared to each directive. A dose difference of 3 Gray (Gy) was considered clinically significant. Compared to the AD and PD, the HD reduced OAR dose objectives by more than 3 Gy in 22% to 75% of cases, depending on OAR. The resulting clinical plan typically met these lower constraints and achieved mean dose reductions between 4.3 and 16 Gy over the PD, and 5.6 to 9.1 Gy over the AD alone. Dose metrics achieved using the HD were significantly better than institutional historical plans for most OARs and NRG constraints for all OARs. The DST facilitated a significantly improved treatment directive across all OARs for this generalized H&N patient cohort, with neither the AD nor PD alone sufficient to optimally direct planning.
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影响因子：
1.2
作者：
Pursley, Jennifer;Damato, Antonio L.;Tishler, Roy B.
通讯作者：
Tishler, Roy B.
影响因子：
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作者：
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作者：
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影响因子：
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作者：
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通讯作者：
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作者：
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通讯作者：
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