Patent Application
20240371494
Embodiments of the present disclosure pertain generally to treatment modality selection.
Radiation therapy (or “radiotherapy”) can be used to treat cancers or other ailments in mammalian (e.g., human and animal) tissue. One such radiotherapy technique involves irradiation with a Gamma Knife, whereby a patient is irradiated by a large number of low-intensity gamma ray beams that converge with high intensity and high precision at a target (e.g., a tumor). In another embodiment, radiotherapy is provided using a linear accelerator, whereby a tumor is irradiated by high-energy particles (e.g., electrons, protons, ions, high-energy photons, and the like). The placement and dose of the radiation beam must be accurately controlled to ensure the tumor receives the prescribed radiation, and the placement of the beam should be such as to minimize damage to the surrounding healthy tissue, often called the organ(s) at risk (OARs). Radiation is termed “prescribed” because a physician orders a predefined amount of radiation to the tumor and surrounding organs similar to a prescription for medicine. Generally, ionizing radiation in the form of a collimated beam is directed from an external radiation source toward a patient.
A specified or selectable beam energy can be used, such as for delivering a diagnostic energy level range or a therapeutic energy level range. Modulation of a radiation beam can be provided by one or more attenuators or collimators (e.g., a multi-leaf collimator (MLC)). The intensity and shape of the radiation beam can be adjusted by collimation to avoid damaging healthy tissue (e.g., OARs) adjacent to the targeted tissue by conforming the projected beam to a profile of the targeted tissue.
The treatment planning procedure may include using a three-dimensional (3D) image of the patient to identify a target region (e.g., the tumor) and to identify critical organs near the tumor. Creation of a treatment plan can be a time-consuming process where a planner tries to comply with various treatment objectives or constraints (e.g., dose volume histogram (DVH), overlap volume histogram (OVH)), taking into account their individual importance (e.g., weighting) in order to produce a treatment plan that is clinically acceptable. This task can be a time-consuming trial-and-error process that is complicated by the various OARs because as the number of OARs increases (e.g., up to thirteen for a head-and-neck treatment), so does the complexity of the process. OARs distant from a tumor may be easily spared from radiation, while OARs close to or overlapping a target tumor may be difficult to spare.
Traditionally, for each patient, the initial treatment plan can be generated in an “offline” manner. The treatment plan can be developed well before radiation therapy is delivered, such as using one or more medical imaging techniques. Imaging information can include, for example, images from X-rays, computed tomography (CT), nuclear magnetic resonance (MR), positron emission tomography (PET), single-photon emission computed tomography (SPECT), or ultrasound. A health care provider, such as a physician, may use 3D imaging information indicative of the patient anatomy to identify one or more target tumors along with the OARs near the tumor(s). The health care provider can delineate the target tumor that is to receive a prescribed radiation dose using a manual technique, and the health care provider can similarly delineate nearby tissue, such as organs, at risk of damage from the radiation treatment. Alternatively, or additionally, an automated tool (e.g., ABAS provided by Elekta AB, Sweden) can be used to assist in identifying or delineating the target tumor and organs at risk. A radiation therapy treatment plan (“treatment plan”) can then be created using an optimization technique based on clinical and dosimetric objectives and constraints (e.g., the maximum, minimum, and fraction of dose of radiation to a fraction of the tumor volume (“95% of target shall receive no less than 100% of prescribed dose”), and like measures for the critical organs). The optimized plan is comprised of numerical parameters that specify the direction, cross-sectional shape, and intensity of each radiation beam.
The treatment plan can then be later executed by positioning the patient in the treatment machine and delivering the prescribed radiation therapy directed by the optimized plan parameters. The radiation therapy treatment plan can include dose “fractioning,” whereby a sequence of radiation treatments is provided over a predetermined period of time (e.g., 30-45 daily fractions), with each treatment including a specified fraction of a total prescribed dose. However, during treatment, the position of the patient and the position of the target tumor in relation to the treatment machine (e.g., linear accelerator—“linac”) is very important in order to ensure the target tumor and not healthy tissue is irradiated.
In the drawings, which are not necessarily drawn to scale, like numerals describe substantially similar components throughout the several views. Like numerals having different letter suffixes represent different instances of substantially similar components. The drawings illustrate generally, by way of example but not by way of limitation, various embodiments discussed in the present document.
In the following detailed description, reference is made to the accompanying drawings which form a part hereof, and which is shown by way of illustration-specific embodiments in which the present disclosure may be practiced. These embodiments, which are also referred to herein as “examples,” are described in sufficient detail to enable those skilled in the art to practice the disclosure, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural, logical and electrical changes may be made without departing from the scope of the present disclosure. The following detailed description is, therefore, not be taken in a limiting sense, and the scope of the present disclosure is defined by the appended claims and their equivalents.
Disease markup and annotation by the physician has inherent variability and bias based on education, residence, practice, experience and exposure. Specifically, the course of treatment for a given disease is usually guided by who the physician is and what experience the physician has with the given disease. The physician may not be up-to-date with the latest standards for treatment and may prescribe a treatment modality for the disease that no longer comports with the current standards. Given the large variability and many types of treatment modalities that can be selected to treat a given disease, patients are put at risk by visiting a physician who is not as experienced and may not be as informed as other physicians. In some cases, a physician may not be aware of all the medical history associated with a patient before prescribing a particular course of treatment or treatment modality. This can severely impact the success or survival rate of treating a given disease. Template-based planning can help reduce variability but may not encompass an extent of personalization or nuance of disease metrics in both the planning images and the patient's electronic medical record (EMR). Also, reviewing all of the medical history for a given patient to come up with a course of treatment (e.g., a treatment modality) is very time consuming, expensive, and can still result in some information being missed.
The disclosed embodiments address these challenges by providing a system that recommends or selects a course of treatment for a given disease based on multiple input parameters associated with a patient. The disclosed embodiments receive multi-parametric input data representing data associated with a patient and receive an indication of a disease associated with the patient. The disclosed embodiments process the multi-parametric input data to generate one or more metrics corresponding to a plurality of different modalities for treating the disease associated with the patient. The disclosed embodiments select, based on the one or more metrics, a given modality from the plurality of different modalities to treat the disease associated with the patient and configure parameters of the given modality based on a portion of the multi-parametric input data. As an example, a machine learning technique can be trained to generate a set of treatment modalities for treating the disease based on the multi-parametric input data. Specifically, the machine learning technique can be trained to establish a relationship between a plurality of characteristics of pre-treatment planning associated with known patients associated with the disease, the modality of the plurality of different modalities used to treat the disease for each of the known patients, and a treatment result of each of the known patients. The machine learning technique can output different weights and metrics of different treatment modalities and a physician or user can use these weights and metrics to select a course of treatment. In some cases, the machine learning technique automatically selects a top ranked course of treatment based on the weights and metrics and recommends the top ranked course of treatment be used to treat the disease.
In this way, an automated system is provided that recommends a treatment modality in a fast and efficient manner. This saves computational resources and the time and expense usually incurred by a physician in prescribing a course of treatment. By automating the process used to select a treatment modality for treating disease given a set of patient data or characteristics, the course of treatment selected for treating the disease can be standardized across a pool of patients in a given region or population. This reduces the amount of variability and discrepancies in results obtained by treating patients associated with a given disease. Also, by automating the manner in which a modality of treatment is selected, the latest standards, rules and regulations set by governing or professional bodies can be considered in generating the metrics that are used to select the treatment modality. In some cases, the automated system can detect that a course of treatment selected to treat the disease differs from that which is standardized or recommended by the automated system. In such circumstances, the automated system can be used for quality control and to generate a prompt, such as if the result obtained by the selected course of treatment has a treatment score that exceeds a specified threshold amount from a score associated with an expected result of the recommended course of treatment. This can be used to flag certain physicians and the protocols those physicians use to improve the overall treatment provided by a given facility.
The image processing device 112 may include a memory device 116, a processor 114, and a communication interface 118. The memory device 116 may store computer-executable instructions, such as an operating system 143, radiation therapy treatment plans 142 (e.g., original treatment plans, adapted treatment plans and the like), software programs 144 (e.g., artificial intelligence, deep learning, neural networks, radiotherapy treatment plan software), and any other computer-executable instructions to be executed by the processor 114.
In one embodiment, the software programs 144 may convert medical images of one format (e.g., MRI) to another format (e.g., CT) by producing synthetic images, such as pseudo-CT images. For instance, the software programs 144 may include image processing programs to train a predictive model for converting a medical image 146 in one modality (e.g., an MRI image) into a synthetic image of a different modality (e.g., a pseudo CT image); alternatively, the trained predictive model may convert a CT image into an MRI image. In another embodiment, the software programs 144 may register the patient image (e.g., a CT image or an MR image) with that patient's dose distribution (also represented as an image) so that corresponding image voxels and dose voxels are associated appropriately by the network. In yet another embodiment, the software programs 144 may substitute functions of the patient images or processed versions of the images that emphasize some aspect of the image information. Such functions might emphasize edges or differences in voxel textures, or any other structural aspect useful to neural network learning. In another embodiment, the software programs 144 may substitute functions of the dose distribution that emphasize some aspect of the dose information. Such functions might emphasize steep gradients around the target or any other structural aspect useful to neural network learning. The memory device 116 may store data, including medical images 146, patient data 145, and other data required to create and implement a radiation therapy treatment plan 142.
In addition to the memory device 116 storing the software programs 144, it is contemplated that software programs 144 may be stored on a removable computer medium, such as a hard drive, a computer disk, a CD-ROM, a DVD, a HD, a Blu-Ray DVD, USB flash drive, a SD card, a memory stick, or any other suitable medium; and the software programs 144 when downloaded to image processing device 112 may be executed by image processor 114.
The processor 114 may be communicatively coupled to the memory device 116, and the processor 114 may be configured to execute computer-executable instructions stored thereon. The processor 114 may send or receive medical images 146 to memory device 116. For example, the processor 114 may receive medical images 146 from the image acquisition device 132 via the communication interface 118 and network. 120 to be stored in memory device 116. The processor 114 may also send medical images 146 stored in memory device 116 via the communication interface 118 to the network 120 be either stored in database 124 or the hospital database 126.
Further, the processor 114 may utilize software programs 144 (e.g., a treatment planning software) along with the medical images 146 and patient data 145 to create the radiation therapy treatment plan 142. Medical images 146 may include information such as imaging data associated with a patient anatomical region, organ, or volume of interest segmentation data. Patient data 145 may include information such as (1) functional organ modeling data (e.g., serial versus parallel organs, appropriate dose response models, etc), (2) radiation dosage data (e.g., DVH information); or (3) other clinical information about the patient and course of treatment (e.g., other surgeries, chemotherapy, previous radiotherapy, etc.).
In addition, the processor 114 may utilize software programs to generate intermediate data such as updated parameters to be used, for example, by a machine learning model, such as a neural network model, or generate intermediate 2D or 3D images, which may then subsequently be stored in memory device 116. The processor 114 may subsequently transmit the executable radiation therapy treatment plan 142 via the communication interface 118 to the network 120 to the radiation therapy device 130, where the radiation therapy plan will be used to treat a patient with radiation. In addition, the processor 114 may execute software programs 144 to implement functions such as image conversion, image segmentation, deep learning, neural networks, and artificial intelligence. For instance, the processor 114 may execute software programs 144 that train or contour a medical image; such software programs 144 when executed may train a boundary detector or utilize a shape dictionary.
The processor 114 may be a processing device, include one or more general-purpose processing devices such as a microprocessor, a central processing unit (CPU), a graphics processing unit (GPU), an accelerated processing unit (APU), or the like. More particularly, the processor 114 may be a complex instruction set computing (CISC) microprocessor, a reduced instruction set computing (RISC) microprocessor, a very long instruction Word (VLIW) microprocessor, a processor implementing other instruction sets, or processors implementing a combination of instruction sets. The processor 114 may also be implemented by one or more special-purpose processing devices such as an application-specific integrated circuit (ASIC), a field programmable gate array (FPGA), a digital signal processor (DSP), a System on a Chip (SoC), or the like. As would be appreciated by those skilled in the art, in some embodiments, the processor 114 may be a special-purpose processor, rather than a general-purpose processor. The processor 114 may include one or more known processing devices, such as a microprocessor from the Pentium™, Core™, Xeon™, or Itanium® family manufactured by Intel™, the Turion™, Athlon™, Sempron™, Opteron™, FX™, Phenom™ family manufactured by AMD™, or any of various processors manufactured by Sun Microsystems. The processor 114 may also include graphical processing units such as a GPU from the GeForce®, Quadro®, Tesla® family manufactured by Nvidia™, GMA, Iris™ family manufactured by Intel™, or the Radeon™ family manufactured by AMD™. The processor 114 may also include accelerated processing units such as the Xeon Phi™ family manufactured by Intel™. The disclosed embodiments are not limited to any type of processor(s) otherwise configured to meet the computing demands of identifying, analyzing, maintaining, generating, and/or providing large amounts of data or manipulating such data to perform the methods disclosed herein. In addition, the term “processor” may include more than one processor (for example, a multi-core design or a plurality of processors each having a multi-core design). The processor 114 can execute sequences of computer program instructions, stored in memory device 116, to perform various operations, processes, methods that will be explained in greater detail below.
The memory device 116 can store medical images 146. In some embodiments, the medical images 146 may include one or more MRI images (e.g., 2D MRI, 3D MRI, 2D streaming MRI, four-dimensional (4D) MRI, 4D volumetric MRI, 4D cine MRI, etc), functional MRI images (e.g., fMRI, DCE-MRI, diffusion MRI), CT images (e.g., 2D CT, cone beam CT, 3D CT, 4D CT), ultrasound images (e.g., 2D ultrasound, 3D ultrasound, 4D ultrasound), one or more projection images representing views of an anatomy depicted in the MRI, synthetic CT (pseudo-CT), and/or CT images at different angles of a gantry relative to a patient axis, PET images, X-ray images, fluoroscopic images, radiotherapy portal images, SPECT images, computer-generated synthetic images (e.g., pseudo-CT images), aperture images, graphical aperture image representations of MLC leaf positions at different gantry angles, and the like. Further, the medical images 146 may also include medical image data, for instance, training images, ground truth images, contoured images, and dose images. In an embodiment, the medical images 146 may be received from the image acquisition device 132. Accordingly, image acquisition device 132 may include an MRI imaging device, a CT imaging device, a PET imaging device, an ultrasound imaging device, a fluoroscopic device, a SPECT imaging device, an integrated linac and MRI imaging device, or other medical imaging devices for obtaining the medical images of the patient. The medical images 146 may be received and stored in any type of data or any type of format that the image processing device 112 may use to perform operations consistent with the disclosed embodiments.
The memory device 116 may be a non-transitory computer-readable medium, such as a read-only memory (ROM), a phase-change random access memory (PRAM), a static random access memory (SRAM), a flash memory, a random access memory (RAM), a dynamic random access memory (DRAM) such as synchronous DRAM (SDRAM), an electrically erasable programmable read-only memory (EEPROM), a static memory (e.g., flash memory, flash disk, static random access memory) as well as other types of random access memories, a cache, a register, a CD-ROM, a DVD or other optical storage, a cassette tape, other magnetic storage device, or any other non-transitory medium that may be used to store information including image, data, or computer executable instructions (e.g., stored in any format) capable of being accessed by the processor 114, or any other type of computer device. The computer program instructions can be accessed by the processor 114, read from the ROM, or any other suitable memory location, and loaded into the RAM for execution by the processor 114. For example, the memory device 116 may store one or more software applications Software applications stored in the memory device 116 may include, for example, an operating system 143 for common computer systems as well as for software-controlled devices. Further, the memory device 116 may store an entire software application, or only a part of a software application, that is executable by the processor 114. For example, the memory device 116 may store one or more radiation therapy treatment plans 142.
The image processing device 112 can communicate with the network 120 via the communication interface 118, which can be communicatively coupled to the processor 114 and the memory device 116. The communication interface 118 may provide communication connections between the image processing device 112 and radiotherapy system 100 components (e.g., permitting the exchange of data with external devices). For instance, the communication interface 118 may, in some embodiments, have appropriate interfacing circuitry to connect to the user interface 136, which may be a hardware keyboard, a keypad, or a touch screen through which a user may input information into radiotherapy system 100.
Communication interface 118 may include, for example, a network adaptor, a cable connector, a serial connector, a USB connector, a parallel connector, a high-speed data transmission adaptor (e.g., such as fiber, USB 3.0, thunderbolt, and the like), a wireless network adaptor (e.g., such as a WiFi adaptor), a telecommunication adaptor (e.g., 3G, 4G/LTE and the like), and the like. Communication interface 118 may include one or more digital and/or analog communication devices that permit image processing device 112 to communicate with other machines and devices, such as remotely located components, via the network 120.
The network 120 may provide the functionality of a local area network (LAN), a wireless network, a cloud computing environment (e.g., software as a service, platform as a service, infrastructure as a service, etc.), a client-server, a wide area network (WAN), and the like. For example, network 120 may be a LAN or a WAN that may include other systems S1 (138), S2 (140), and S3 (141). Systems S1. S2, and S3 may be identical to image processing device 112 or may be different systems. In some embodiments, one or more systems in network 120 may form a distributed computing/simulation environment that collaboratively performs the embodiments described herein. In some embodiments, one or more systems S1, S2, and S3 may include a CT scanner that obtains CT images (e.g., medical images 146) In addition, network 120 may be connected to Internet 122 to communicate with servers and clients that reside remotely on the internet.
Therefore, network 120 can allow data transmission between the image processing device 112 and a number of various other systems and devices, such as the OIS 128, the radiation therapy device 130, and the image acquisition device 132. Further, data generated by the OIS 128 and/or the image acquisition device 132 may be stored in the memory device 116, the database 124, and/or the hospital database 126. The data may be transmitted/received via network 120, through communication interface 118 in order to be accessed by the processor 114, as required.
The image processing device 112 may communicate with database 124 through network 120 to send/receive a plurality of various types of data stored on database 124. For example, database 124 may include machine data (control points) that includes information associated with a radiation therapy device 130, image acquisition device 132, or other machines relevant to radiotherapy. Machine data information may include control points, such as radiation beam size, are placement, beam on and off time duration, machine parameters, segments, MLC configuration, gantry speed, MRI pulse sequence, and the like. Database 124 may be a storage device and may be equipped with appropriate database administration software programs. One skilled in the art would appreciate that database 124 may include a plurality of devices located either in a central or a distributed manner.
In some embodiments, database 124 may include a processor-readable storage medium (not shown). While the processor-readable storage medium in an embodiment may be a single medium, the term “processor-readable storage medium” should be taken to include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more sets of computer-executable instructions or data. The term “processor-readable storage medium” shall also be taken to include any medium that is capable of storing or encoding a set of instructions for execution by a processor and that cause the processor to perform any one or more of the methodologies of the present disclosure. The term “processor-readable storage medium” shall accordingly be taken to include, but not be limited to, solid-state memories and optical and magnetic media. For example, the processor-readable storage medium can be one or more volatile, non-transitory, or non-volatile tangible computer-readable media.
Image processor 114 may communicate with database 124 to read images into memory device 116 or store images from memory device 116 to database 124. For example, the database 124 may be configured to store a plurality of images (e.g., 3D MRI, 4D MRI, 2D MRI slice images, CT images, 2D Fluoroscopy images, X-ray images, raw data from MR scans or CT scans, Digital Imaging and Communications in Medicine (DIMCOM) data, projection images, graphical aperture images, etc.) that the database 124 received from image acquisition device 132. Database 124 may store data to be used by the image processor 114 when executing software program 144 or when creating radiation therapy treatment plans 142. Database 124 may store the data produced by the trained machine learning mode, such as a neural network including the network parameters constituting the model learned by the network and the resulting estimated data. As referred to herein, “estimate” or “estimated” can be used interchangeably with predict or predicted and should be understood to have the same meaning. The image processing device 112 may receive the imaging data, such as a medical image 146 (e.g., 2D MRI slice images, CT images, 2D Fluoroscopy images, X-ray images, 3DMRI images, 4D MRI images, projection images, graphical aperture images, image contours, etc.) from the database 124, the radiation therapy device 130 (e.g., an MR-linac), and/or the image acquisition device 132 to generate a treatment plan 142.
In an embodiment, the radiotherapy system 100 can include an image acquisition device 132 that can acquire medical images (e.g., MRI images, 3D MRI, 2D streaming MRI, 4D volumetric MRI, CT images, cone-Beam CT, PET images, functional MRI images (e.g., fMRI, DCE-MRI and diffusion MRI), X-ray images, fluoroscopic image, ultrasound images, radiotherapy portal images, SPECT images, and the like) of the patient. Image acquisition device 132 may, for example, be an MRI imaging device, a CT imaging device, a PET imaging device, an ultrasound device, a fluoroscopic device, a SPECT imaging device, or any other suitable medical imaging device for obtaining one or more medical images of the patient. Images acquired by the image acquisition device 132 can be stored within database 124 as either imaging data and/or test data By way of example, the images acquired by the image acquisition device 132 can be also stored by the image processing device 112, as medical image 146 in memory device 116.
In an embodiment, for example, the image acquisition device 132 may be integrated with the radiation therapy device 130 as a single apparatus (e.g., an MR-linac). Such an MR-linac can be used, for example, to determine a location of a target organ or a target tumor in the patient, so as to direct radiation therapy accurately according to the radiation therapy treatment plan 142 to a predetermined target.
The image acquisition device 132 can be configured to acquire one or more images of the patient's anatomy for a region of interest (e.g., a target organ, a target tumor, or both). Each image, typically a 2D image or slice, can include one or more parameters (e.g., a 2D slice thickness, an orientation, and a location, etc.). In an embodiment, the image acquisition device 132 can acquire a 2D slice in any orientation. For example, an orientation of the 2D slice can include a sagittal orientation, a coronal orientation, or an axial orientation. The processor 114 can adjust one or more parameters, such as the thickness and/or orientation of the 2D slice, to include the target organ and/or target tumor. In an embodiment, 2D slices can be determined from information such as a 3D MRI volume. Such 2D slices can be acquired by the image acquisition device 132 in “real-time” while a patient is undergoing radiation therapy treatment, for example, when using the radiation therapy device 130, with “real-time” meaning acquiring the data in at least milliseconds or less.
The image processing device 112 may generate and store radiation therapy treatment plans 142 for one or more patients. The radiation therapy treatment plans 142 may provide information about a particular radiation dose to be applied to each patient. The radiation therapy treatment plans 142 may also include other radiotherapy information, such as control points including beam angles, gantry angles, beam intensity, dose-histogram-volume information, the number of radiation beams to be used during therapy, the dose per beam, and the like.
The image processor 114 may generate the radiation therapy treatment plan 142 by using software programs 144 such as treatment planning software (such as Monaco®, manufactured by Elekta AB of Stockholm, Sweden). In order to generate the radiation therapy treatment plans 142, the image processor 114 may communicate with the image acquisition device 132 (e.g., a CT device, an MRI device, a PET device, an X-ray device, an ultrasound device, etc.) to access images of the patient and to delineate a target, such as a tumor, to generate contours of the images. In some embodiments, the delineation of one or more OARs, such as healthy tissue surrounding the tumor or in close proximity to the tumor, may be required. Therefore, segmentation of the OAR may be performed when the OAR is close to the target tumor In addition, if the target tumor is close to the OAR (e.g., prostate in near proximity to the bladder and rectum), then by segmenting the OAR from the tumor, the radiotherapy system 100 may study the dose distribution not only in the target but also in the OAR.
In order to delineate a target organ or a target tumor from the OAR, medical images, such as MRI images, CT images, PET images, fMRI images, X-ray images, ultrasound images, radiotherapy portal images, SPECT images, and the like, of the patient undergoing radiotherapy may be obtained non-invasively by the image acquisition device 132 to reveal the internal structure of a body part Based on the information from the medical images, a 3D structure of the relevant anatomical portion may be obtained and used to generate a contour of the image. Contours of the image can include data overlaid on top of the image that delineates one or more structures of the anatomy. In some cases, the contours can be files associated with respective images that specify the coordinates or 2D or 3D locations of various structures of the anatomy depicted in the images.
In addition, during a treatment planning process, many parameters may be taken into consideration to achieve a balance between efficient treatment of the target tumor (e.g., such that the target tumor receives enough radiation dose for an effective therapy) and low irradiation of the OAR(s) (e.g., the OAR(s) receives as low a radiation dose as possible) Other parameters that may be considered include the location of the target organ and the target tumor, the location of the OAR, and the movement of the target in relation to the OAR. For example, the 3D structure may be obtained by contouring the target or contouring the OAR within each 2D layer or slice of an MRI or CT image and combining the contour of each 2D layer or slice. The contour may be generated manually (e.g., by a physician, dosimetrist, or health care worker using a program such as MONACO™ manufactured by Elekta AB of Stockholm, Sweden) or automatically (e.g., using a program such as the Atlas-based auto-segmentation software, ABAS™, manufactured by Elekta AB of Stockholm, Sweden). In certain embodiments, the 3D structure of a target tumor or an OAR may be generated automatically by the treatment planning software.
After the target tumor and the OAR(s) have been located and delineated, a dosimetrist, physician, or healthcare worker may determine a dose of radiation to be applied to the target tumor, as well as any maximum amounts of dose that may be received by the OAR proximate to the tumor (e.g., left and right parotid, optic nerves, eyes, lens, inner ears, spinal cord, brain stem, and the like). After the radiation dose is determined for each anatomical structure (e.g., target tumor, OAR), a process known as inverse planning may be performed to determine one or more treatment plan parameters that would achieve the desired radiation dose distribution. Examples of treatment plan parameters include volume delineation parameters (e.g., which define target volumes, contour sensitive structures, etc), margins around the target tumor and OARs, beam angle selection, collimator settings, and beam-on times. During the inverse-planning process, the physician may define dose constraint parameters that set bounds on how much radiation an OAR may receive (e.g., defining full dose to the tumor target and zero dose to any OAR, defining 95% of dose to the target tumor; defining that the spinal cord, brain stem, and optic structures receive≤45Gy, ≤55Gy and <54Gy, respectively). The result of inverse planning may constitute a radiation therapy treatment plan 142 that may be stored in memory device 116 or database 124. Some of these treatment parameters may be correlated. For example, tuning one parameter (e.g., weights for different objectives, such as increasing the dose to the target tumor) in an attempt to change the treatment plan may affect at least one other parameter, which in turn may result in the development of a different treatment plan. Thus, the image processing device 112 can generate a tailored radiation therapy treatment plan 142 having these parameters in order for the radiation therapy device 130 to provide radiotherapy treatment to the patient.
In addition, the radiotherapy system 100 may include a display device 134 and a user interface 136. The display device 134 may include one or more display screens that display medical images, interface information, treatment planning parameters (e.g., projection images, graphical aperture images, contours, dosages, beam angles, etc.) treatment plans, a target, localizing a target and/or tracking a target, or any related information to the user. The user interface 136 may be a keyboard, a keypad, a touch screen or any type of device that a user may use to input information to radiotherapy system 100. Alternatively, the display device 134 and the user interface 136 may be integrated into a device such as a tablet computer (e.g., Apple iPad®, Lenovo ThinkPad®, Samsung Galaxy®, etc.).
Furthermore, any and all components of the radiotherapy system 100 may be implemented as a virtual machine (e.g., VMWare, Hyper-V, and the like). For instance, a virtual machine can be software that functions as hardware. Therefore, a virtual machine can include at least one or more virtual processors, one or more virtual memories, and one or more virtual communication interfaces that together function as hardware. For example, the image processing device 112, the OIS 128, and the image acquisition device 132 could be implemented as a virtual machine. Given the processing power, memory, and computational capability available, the entire radiotherapy system 100 could be implemented as a virtual machine.
The treatment modality selection device 150 may include similar components as the image processing device 112 with similar functionality. In some cases, the treatment modality selection device 150 is integrated as part of the image processing device 112. The treatment modality selection device 150 is configured to receive or access multi-parametric input data representing data associated with a patient. For example, the treatment modality selection device 150 accesses, as part of the multi-parametric input data, EMR information stored in the database 124 and imaging information stored in the medical images 146. In some cases, the treatment modality selection device 150 and/or the database 124 can also access a questionnaire filled out by a given patient to determine additional, more recent information about the patient than what is already stored in the database 124. The treatment modality selection device 150 and/or the database 124 can detect differences between data input in the questionnaire and the data stored in the database 124. The treatment modality selection device 150 and/or the database 124 can update the data stored in the database 124 for the patient with the more recent data input in the questionnaire. For example, the database 124 may Jack an indication that the patient has recently had surgery to remove a kidney. The questionnaire may have a field requesting input from the patient about recent surgeries. The treatment modality selection device 150 and/or the database 124 can detect that the field has been populated with an indication that surgery was performed recently (in the past week) to remove a kidney. In response, the treatment modality selection device 150 and/or the database 124 automatically updates the corresponding EMR information stored in the database 124 to indicate that the patient has only one kidney.
The multi-parametric input data can include any combination of one or more image features, one or more features derived from an image, clinical data, and EMR information associated with the patient. The one or more image features can include a size, volume, or intensity of a region of interest, such as a prostate. The one or more features derived from an image can include radiomics features including texture and gradients of the one or more image features. The clinical data can include staging, genomics, and/or one or more tumor-specific features, such as: a Gleason score, a prostate-specific antigen (PSA) score, previous surgical intervention data, previous radiation treatments information, previous systemic therapies information, proximity to organs at risk data, obstructive symptoms information, presence of specific heritable pathogenic variants information, laterality information, morphology information, ethnicity information, gene panels information, genetic mutations information, ultrasound data, endoscopy data, physical examination results, urine test information, blood test information, biopsy data, Human papillomavirus infection (HPV) infection, gender, age, Epstein-Barr infection information, clear surgical margins data, Eastern Cooperative Oncology Group (ECOG) status information, radiosensitising conditions information, collagen vascular disease information, Non-invasive ductal carcinoma in situ information, body mass index (BMI) information, level of T-Cells in a body information, pregnancy status information, suitability of surgery information, and positron emission tomography (PET) staging information.
The multi-parametric input data can also include one or more outcome metrics, such as: toxicities, disease-free survival information for previous patients with the disease, or reimbursement information for a plurality of different treatment modalities. For example, the multi-parametric input data can include a table or list of diseases along with their respective survival rates for different treatment modalities. As referred to herein, a “modality” or “treatment modality” is defined as an intervention technique for treating a disease, such as performing surgery, performing radiotherapy, performing chemotherapy, performing immunotherapy, performing targeted therapy, performing hormone therapy, performing a stem cell transplant, performing precision medicine, any combination of performing surgery, performing radiotherapy, performing chemotherapy, performing immunotherapy, performing targeted therapy, performing hormone therapy, performing a stem cell transplant, performing precision medicine, and preventing performance of any treatment. The reimbursement information represents the amount of resources or money paid to the provider or physician for performing a given treatment modality. The multi-parametric input data can include for each disease and each treatment modality information representing how much radiation or toxicity resulted from implementing the given treatment modality and the survival information associated with the given treatment modality. As referred to herein, “treating a disease” can mean providing treatment to help lessen the symptoms and adverse effects of a disease, such as to reduce a size of a tumor or eliminate cancer cells. Disease treatment can involve one or multiple rounds of one or combination of different treatment modalities (e.g., therapy, surgery, medicine, and so forth).
The treatment modality selection device 150 can receive an indication of a disease associated with the patient. For example, the treatment modality selection device 150 can automatically process the multi-parametric input data to derive or determine a most likely disease (e.g., type of cancer, region of tumor cells, type of genetic disease, type of physiological disease, such as diabetes, multiple sclerosis, Crohn's & Colitis, lupus, rheumatoid arthritis, celiac disease, scleroderma, liver disease, cancer, heart disease, and so forth) associated with the patient. In another embodiment, the treatment modality selection device 150 can present a user interface to a provider or physician that allows the provider or physician to input the disease (e.g., type of cancer, region of tumor cells, type of genetic disease, type of physiological disease, such as diabetes, multiple sclerosis, Crohn's & Colitis, lupus, rheumatoid arthritis, celiac disease, scleroderma, liver disease, cancer, heart disease, and so forth) associated with the patient and for which the multi-parametric input data was received. In some cases, the user interface provides an abbreviated list of possible diseases (e.g., type of cancer and region of tumor cells) automatically selected by the treatment modality selection device 150 based on the multi-parametric input data. The treatment modality selection device 150 then receives a selection from the provider or physician from the abbreviated list of possible diseases. This improves the efficiency at which the disease infecting the given patient is identified and reduces the overall number of user interfaces and pages of information the provider or physician has to navigate through to identify the disease of interest associated with the patient.
After receiving the multi-parametric input data associated with the patient and after identifying the disease associated with the patient, the treatment modality selection device 150 processes the multi-parametric input data to generate one or more metrics corresponding to a plurality of different modalities for treating the identified disease associated with the patient. For example, the treatment modality selection device 150 can use any one or a combination of heuristics, look-up tables, and machine learning models to process the multi-parametric input data to generate the metrics corresponding to the different modalities for treating the identified disease. Specifically, the treatment modality selection device 150 can generate various scores or weights for each possible or a subset of possible treatment modalities as the one or more metrics. The process for training the treatment modality selection device 150 to generate the one or more metrics for different treatment modalities is discussed in more detail below in connection with
In one example, the treatment modality selection device 150 can determine, based on processing the multi-parametric input data, that radiotherapy has a higher survival rate for treating the prostate cancer disease associated with the patient than chemotherapy or surgery. As a result, the treatment modality selection device 150 can assign a greater weight to the radiotherapy treatment modality than the chemotherapy and surgery modalities. Specifically, the treatment modality selection device 150 can associate radiotherapy with a score of 80, chemotherapy with a score of 15, and surgery with a score of 5 based on the past survival rate information of the different treatment modalities available for treating the identified prostate cancer disease.
In one example, the treatment modality selection device 150 can determine, based on processing the multi-parametric input data, that chemotherapy has a higher reimbursement value for treating the prostate cancer disease associated with the patient than radiotherapy. As a result, the treatment modality selection device 150 can assign a greater weight to the chemotherapy treatment modality than the radiotherapy modality. Specifically, the treatment modality selection device 150 can associate chemotherapy with a score of 60 and radiotherapy with a score of 40 based on the reimbursement value information of the different treatment modalities available for treating the identified prostate cancer disease.
In one example, the treatment modality selection device 150 can determine, based on processing the multi-parametric input data, that radiotherapy (1) has a higher survival rate for treating the prostate cancer disease associated with the patient than chemotherapy or surgery, (2) is associated with a higher reimbursement value and (3) is the governmental body or regulatory authority recommended course for treating prostate cancer. As a result, the treatment modality selection device 150 can assign a greater weight to the radiotherapy treatment modality than the chemotherapy and surgery modalities. Specifically, the treatment modality selection device 150 can associate radiotherapy with a score of 80, chemotherapy with a score of 10, and surgery with a score of 10 based on the past survival rate information of the different treatment modalities available for treating the identified prostate cancer disease, the reimbursement value and the governmental body or regulatory authority recommended course for treating prostate cancer.
In some embodiments, the treatment modality selection device 150 can select a given modality from the plurality of different modalities to treat the disease associated with the patient. In one implementation, the treatment modality selection device 150 automatically selects a highest ranked or highest scored treatment modality for treating the disease associated with the patient. In this case, no input is received from the provider or physician and the template or parameters of the given treatment modality are automatically generated and configured. In another implementation, the treatment modality selection device 150 presents a user interface to a provider or physician that identifies the disease associated with the patient and displays a list of the different modalities for treating the disease along with the corresponding metrics of each modality. Namely, the treatment modality selection device 150 can present a user interface that displays the possible treatment modalities in ranked order or according to the associated scores of each treatment modality.
Input can be received by the treatment modality selection device 150 from the provider or physician that selects a given one of the treatment modalities that are displayed. In some cases, the provider or physician selects a treatment modality that is associated with a lower score than other treatment modalities. Specifically, the provider or physician can select a treatment modality as the given modality for treating the patient that is ranked lower and displayed in a lower position in the list in the user interface. In such cases, a warning or prompt can be displayed to the physician or provider indicating that the selected treatment modality is not the highest ranked treatment modality. The warning or prompt can identify the highest ranked treatment modality. The warning or prompt can request confirmation from the provider or physician to proceed with the selected treatment modality as the given modality used to treat the patient. The warning or prompt can allow the provider or physician to select the highest ranked treatment modality instead of the treatment modality previously selected by the provider or physician. In these circumstances, if the provider or physician confirms proceeding with the lower ranked treatment modality as the modality used to treat the patient, the action can be recorded in a file associated with the provider or physician for performing quality assurance (QA).
In certain cases, the treatment modality selection device 150 can track the treatment results or survival rate of the treatment modality selected by the provider or physician. The treatment modality selection device 150 can compare the results or the survival rate with the survival rate or survival score of the highest ranked treatment modality that was not selected as the given modality to treat the patient. If the treatment modality selection device 150 detects that the survival rate or results are associated with a score that is lower than the survival rate or score of the highest ranked treatment modality by more than a threshold (e.g., by more than 10 percent), the treatment modality selection device 150 can trigger a prompt or warning to a supervisor or other healthcare monitoring facility. The prompt or warning can cause the supervisor or healthcare monitoring facility to audit the physician or provider. As an example, the treatment modality selection device 150 can recommend as the highest ranked treatment modality radiotherapy for treating prostate cancer. The provider can select a different treatment modality, such as chemotherapy, to treat the prostate cancer. The radiotherapy treatment modality can be associated with a survival rate score of 80%. The treatment modality selection device 150 can determine that as a result of treating the patient with chemotherapy instead of the highest ranked radiotherapy, the survival rate or result score was 40%. The treatment modality selection device 150 can determine that the survival rate or result score is more than 10% lower than the survival rate score of the radiotherapy treatment modality. As a result, the treatment modality selection device 150 can flag the file of the provider to cause the provider to be audited for failing to follow the recommended protocol or failing to follow the highest ranked treatment modality recommended by the treatment modality selection device 150.
In some embodiments, the treatment modality selection device 150 can configure one or more parameters of the given treatment modality, such as using some of the multi-parametric input data. For example, the treatment modality selection device 150 can retrieve from the database 124 a blank template associated with the given treatment modality that has been selected. The blank template can be processed to identify the fields of the template. The patient information derived from the multi-parametric input data, such as image features, EMR information, clinical information and so forth can be used to populate the fields of the template. The treatment modality selection device 150 can also specify in the template a type of the given treatment modality to apply. For example, if the selected treatment modality is radiotherapy, the treatment modality selection device 150 can specify the type of radiotherapy (e.g., a selection between external beam radiation therapy, gamma knife, stereotactic radiation therapy, and so forth) to use in the radiotherapy template. The treatment modality selection device 150 can select or specify the amount of dose a patient will receive based on intensity information contained in a PET scan of the region of interest.
The treatment modality selection device 150 can transmit the populated template to a suitable modality execution module, such as a radiotherapy planning system Specifically, the treatment modality selection device 150 can transmit the populated radiotherapy template to the image processing device 112. The image processing device 112 can then apply one or more automated radiotherapy planning techniques to generate a suitable radiotherapy treatment plan based on the information included in the populated template. As mentioned above, once the radiotherapy treatment plan is generated by the image processing device 112, the image processing device 112 can instruct the radiation therapy device 130 to perform radiotherapy on the patient according to the parameters specified in the automatically generated radiotherapy treatment plan.
The treatment modality selection device 150 can receive outcome information from the modality execution module, such as the survival rate information, toxicity information, tumor reduction information or amount, and other outcome specific information. This output information can be used as new training data to update a model implemented by the treatment modality selection device 150. The treatment modality selection device 150 can update the model used to generate the one or more metrics of each of the plurality of different treatment modalities based on the outcome information received from the modality execution module. In this way, the machine learning technique implemented by the treatment modality selection device 150 can continuously or periodically be updated based on new training data generated based on application of a previously selected treatment modality and outcome information from the treatment modality.
Referring back to
The coordinate system (including axes A, T, and L) shown in
Gantry 206 may also have an attached imaging detector 214. The imaging detector 214 is preferably located opposite to the radiation source, and in an embodiment, the imaging detector 214 can be located within a field of the therapy beam 208.
The imaging detector 214 can be mounted on the gantry 206 (preferably opposite the radiation therapy output 204), such as to maintain alignment with the therapy beam 208. The imaging detector 214 rotates about the rotational axis as the gantry 206 rotates. In an embodiment, the imaging detector 214 can be a flat panel detector (e.g., a direct detector or a scintillator detector). In this manner, the imaging detector 214 can be used to monitor the therapy beam 208 or the imaging detector 214 can be used for imaging the patient's anatomy, such as portal imaging. The control circuitry of radiation therapy device 202 may be integrated within system 100 or remote from it.
In an illustrative embodiment, one or more of the couch 216, the therapy output 204, or the gantry 206 can be automatically positioned, and the therapy output 204 can establish the therapy beam 208 according to a specified dose for a particular therapy delivery instance. A sequence of therapy deliveries can be specified according to a radiation therapy treatment plan, such as using one or more different orientations or locations of the gantry 206, couch 216, or therapy output 204. The therapy deliveries can occur sequentially, but can intersect in a desired therapy locus on or within the patient, such as at the isocenter 210. A prescribed cumulative dose of radiation therapy can thereby be delivered to the therapy locus while damage to tissue near the therapy locus can be reduced or avoided.
In the illustrative embodiment of
Couch 216 may support a patient (not shown) during a treatment session. In some implementations, couch 216 may move along a horizontal translation axis (labelled “T”), such that couch 216 can move the patient resting on couch 216 into and/or out of system 300. Couch 216 may also rotate around a central vertical axis of rotation, transverse to the translation axis. To allow such movement or rotation, couch 216 may have motors (not shown) enabling the couch to move in various directions and to rotate along various axes. A controller (not shown) may control these movements or rotations in order to properly position the patient according to a treatment plan.
In some embodiments, image acquisition device 320 may include an MRI machine used to acquire 2D or 3D MRI images of the patient before, during, and/or after a treatment session. Image acquisition device 320 may include a magnet 321 for generating a primary magnetic field for magnetic resonance imaging. The magnetic field lines generated by operation of magnet 321 may run substantially parallel to the central translation axis I. Magnet 321 may include one or more coils with an axis that runs parallel to the translation axis I. In some embodiments, the one or more coils in magnet 321 may be spaced such that a central window 323 of magnet 321 is free of coils. In other embodiments, the coils in magnet 321 may be thin enough or of a reduced density such that they are substantially transparent to radiation of the wavelength generated by radiotherapy device 330. Image acquisition device 320 may also include one or more shielding coils, which may generate a magnetic field outside magnet 321 of approximately equal magnitude and opposite polarity in order to cancel or reduce any magnetic field outside of magnet 321. As described below, radiation source 331 of radiotherapy device 330 may be positioned in the region where the magnetic field is cancelled, at least to a first order, or reduced.
Image acquisition device 320 may also include two gradient coils 325 and 326, which may generate a gradient magnetic field that is superposed on the primary magnetic field. Coils 325 and 326 may generate a gradient in the resultant magnetic field that allows spatial encoding of the protons so that their position can be determined Gradient coils 325 and 326 may be positioned around a common central axis with the magnet 321 and may be displaced along that central axis. The displacement may create a gap, or window, between coils 325 and 326. In embodiments where magnet 321 can also include a central window 323 between coils 325 and 326, the two windows may be aligned with each other.
In some embodiments, image acquisition device 320 may be an imaging device other than an MRI, such as an X-ray, a CT, a CBCT, a spiral CT, a PET, a SPECT, an optical tomography, a fluorescence imaging, ultrasound imaging, radiotherapy portal imaging device, or the like. As would be recognized by one of ordinary skill in the art, the above description of image acquisition device 320 concerns certain embodiments and is not intended to be limiting.
Radiotherapy device 330 may include the radiation source 331, such as an X-ray source or a linac, and an MLC 332 (shown below in
During a radiotherapy treatment session, a patient may be positioned on couch 216. System 300 may then move couch 216 into the treatment area defined by magnet 321, coils 325 and 326, and chassis 335. Control circuitry may then control radiation source 331, MLC 332, and the chassis motor(s) to deliver radiation to the patient through the window between coils 325 and 326 according to a radiotherapy treatment plan.
As discussed above, radiation therapy devices described by
Inputs 704 can include a defined deep learning model (which can include one or more sub-networks or one or more individual and independent machine learning models) having an initial set of values (e.g., nominal startup values or random DCNN parameter values) and training data. The training data can include multi-parametric input data, such as any combination of one or more image features, one or more features derived from an image, clinical data, EMR information associated with the patient, and outcome metrics. The training data can include characteristics of pre-treatment planning associated with a plurality of known patients, a treatment modality used to treat the disease for the plurality of known patients, and the treatment result of the plurality of known patients. The training data can also include government or professional body regulations for treating the disease, and reimbursement information of each of the plurality of different modalities. The training data can also include data sets, where each data set includes a first set of characteristics of pre-treatment planning associated with a given known patient (e.g., the image features, features derived from one or more images of the known patient, clinical data associated with the known patient, and EMR information associated with the known patient), a modality used to treat the disease for the given known patient, and the treatment result (outcome metric) of the given known patient. The training data can include multiple of these paired data sets for multiple patients.
The clinical data can include any combination of a Gleason score, a PSA score, previous surgical intervention data, previous radiation treatments information, previous systemic therapies information, proximity to organs at risk data, obstructive symptoms information, presence of specific heritable pathogenic variants information, laterality information, morphology information, ethnicity information, gene panels information, genetic mutations information, ultrasound data, endoscopy data, physical examination results, urine test information, blood test information, biopsy data, HPV infection, gender, age, Epstein-Barr infection information, clear surgical margins data, Eastern Cooperative Oncology Group (ECOG) status information (which can describe a patient's level of functioning in terms of their ability to care for themselves, daily activity and physical ability ranging from grades 0-5, in which: grade 0 defines a patient who is fully active, able to carry on all pre-disease performance without restriction, grade 1 defines a patient restricted in their physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature; grade 2 defines a patient who is ambulatory and capable of all selfcare but unable to carry out any work activities; grade 3 defines a patient who is capable of only limited selfcare and is confined to a bed or chair more than 50% of waking hours; grade 4 defines a completely disabled patient; and grade 5 is a dead patient), radiosensitising agent conditions information, collagen vascular disease information, Non-invasive ductal carcinoma in situ information, BMI information, level of T-Cells in a body information, pregnancy status information, suitability of surgery information, and PET staging information.
The deep learning model can include one or more neural networks (referred to as sub-networks), such as a DCNN. The deep learning network can be trained on the training data to establish a relationship between a plurality of characteristics of pre-treatment planning associated with known patients associated with the disease, the modality of the plurality of different modalities used to treat the disease for each of the known patients, and a treatment result of each of the known patients. In one embodiment, the deep learning network is trained in an end-to-end manner in which all of the sub-networks are trained simultaneously by being applied to a same set or batch of training data and minimizing a set of cost functions. In another embodiment, one or more of the sub-networks of the DCNN are trained separately and independently in sequence by minimizing a set of cost functions associated with each particular sub-network. In some cases, each sub-network of the DCNN is disease specific such that it is trained based on a respective set of the training data associated with a specific disease. In this way, different sub-networks of the DCNN are configured to estimate a set of modalities for treating different diseases associated with the respective sub-networks. For example, a first sub-network can be configured to estimate a set of modalities for treating breast cancer (e.g., a first disease) and a second sub-network can be configured to estimate a set of modalities for treating prostate cancer (e.g., a second disease).
The training data can include medical images of the known patients that can include images of an anatomy, CT images, PET images, or MRI images. When trained, the deep learning network can produce an estimate of a set of modalities for treating the disease and their respective metrics (e.g., ranking or weights). The expected results can include the actual modality used to treat a given known patient and the corresponding survival and/or toxicity information.
During training of deep learning (DL) model 708, a batch of training data can be selected from the pairs of the training data of known patients and expected results (e.g., the corresponding actual modalities used to treat the patients and/or the modalities specified by the governmental or professional bodies as recommended modalities for treating the disease and/or the reimbursement values or information associated with different treatment modalities for treating the disease). The selected training data can include a portion of the training data corresponding to a given known patient of the known patients, the portion of the training data comprising characteristics of pre-treatment planning associated with the given known patient, the modality used to treat the disease for the given known patient, and the treatment result of the given known patient. In the case of end-to-end training, the batch of training data can be processed by all of the sub-networks of the DL model 708 simultaneously.
The deep learning model 708 can be applied to the selected training data to provide estimated results (e.g., estimated set of modalities for treating the disease of the given known patient), which can then be compared to the expected results (e.g., the actual modalities used to treat the patients, the treatment results, survival rate, toxicity information and/or the modalities specified by the governmental or professional bodies as recommended modalities for treating the disease and/or the reimbursement values or information associated with different treatment modalities for treating the disease) to compute a difference or deviation that can provide an indication of training errors. The difference or deviation can be used to compute a loss function. The loss function can be computed based on a deviation parameter and a treatment result parameter. The deviation parameter can be determined based a result of comparing the modality used to treat the disease for the given known patient with the estimated set of modalities. The treatment result parameter can be determined based on the treatment result (e.g., the survival rate and/or toxicity information) of the given known patient. In some cases, the loss function further includes a reimbursement parameter specifying a level of reimbursement of each of the modalities for treating the disease. In some cases, the loss function further includes a government or professional body regulations parameter specifying a modality for treating the disease given a set of characteristics.
In some cases, the DCNN is trained to generate a weight for each of the set of modalities for treating the disease of the given known patient. The weight can be generated based on the computed loss function. For example, the DCNN can compute the loss function for each of a plurality of the estimated treatment modalities. The DCNN can compare the value of the loss or the errors associated with each selected treatment modality and can rank the treatment modalities or generate the metrics of each treatment modality as a function of the amount of the loss or errors. For example, if a first treatment modality is associated with a lower loss (e.g., because the survival rate indicated by the treatment result parameter is greater and the toxicity information is lower) than a second treatment modality, the DCNN can rank the first treatment modality higher than the second treatment modality.
The errors or result of computing the loss function can be used during a procedure called backpropagation to update the parameters of the deep learning network (e.g., layer node weights and biases of each or of certain sub-networks of the model 708), in order to reduce or minimize errors during subsequent trials. The errors or result of computing the loss function can be compared to predetermined criteria, such as proceeding to a sustained minimum for a specified number of training iterations. If the errors or result of computing the loss function do not satisfy the predetermined criteria, then model parameters of the deep learning model 708 can be updated using backpropagation, and another batch of training data can be selected from the other sets of training data (of the same patient or other patients) and expected results for another iteration of deep learning model training. If the errors or result of computing the loss function satisfy the predetermined criteria, then the training can be ended, and the trained model 708 can then be used during a deep learning testing or inference stage 712 to generate one or more metrics for different treatment modalities for treating a disease associated with a new patient. The trained model 708 can receive new multi-parametric data for the new patient and can provide estimated results (e.g., the estimated set of modalities for treating the disease of the new patient).
After updating the parameters of the DCNN, the iteration index can be incremented by a value of one. The iteration index can correspond to a number of times that the parameters of the DCNN have been updated. Stopping criteria can be computed, and if the stopping criteria are satisfied, then the DCNN model can be saved in a memory, such as a memory device of treatment modality selection device 150, and the training can be halted. If the stopping criteria are not satisfied, then the training can continue by obtaining another batch of training data from the same training subject or another training subject. In an embodiment, the stopping criteria can include a value of the iteration index (e.g., the stopping criteria can include whether the iteration index is greater than or equal to a determined maximum number of iterations). In an embodiment, the stopping criteria can include an accuracy of the output treatment modalities or metrics of the different treatment modalities (e.g., the stopping criteria can include whether the difference between the output treatment modalities or metrics of the different treatment modalities and the actual modalities used to treat the patients and/or the modalities specified by the governmental or professional bodies as recommended modalities for treating the disease and/or the reimbursement values or information associated with different treatment modalities for treating the disease in the batch of training data is smaller than a threshold).
In some embodiments, the DL model 708 is re-trained to estimate a set of treatment modalities and corresponding metrics for a different disease. Namely, the DL model 708 can be trained to generate a set of modalities for treating a second disease based on additional training data comprising a plurality of characteristics of pre-treatment planning associated with known patients associated with the second disease, the modality of the plurality of different modalities used to treat the second disease for each of the known patients, and a treatment result of each of the known patients associated with the second disease. The steps recited above for training the DL model 708 can be repeated for each set or batch of training data associated with different diseases.
After the DL model 708 is trained, multi-parametric input data representing data associated with a patient or an anatomy can be received, such as from the database 124. The multi-parametric input data can include any combination of one or more image features, one or more features derived from an image, clinical data, and EMR information associated with the patient. The trained DONN model can be received from a network, such as the network 120, or from a memory, such as the memory device of the treatment modality selection device 150. The trained DCNN can be used to determine the one or more metrics corresponding to a plurality of different modalities for treating the disease associated with the patient based on the multi-parametric input data. As an example, the clinical data associated with the patient can include any combination of a Gleason score, a prostate-specific antigen (PSA) score, previous surgical intervention data, previous radiation treatments information, previous systemic therapies information, proximity to organs at risk data, obstructive symptoms information, presence of specific heritable pathogenic variants information, laterality information, morphology information, ethnicity information, gene panels information, genetic mutations information, ultrasound data, endoscopy data, physical examination results, urine test information, blood test information, biopsy data, Human papillomavirus infection (HPV) infection, gender, age, Epstein-Barr infection information, clear surgical margins data, Eastern Cooperative Oncology Group (ECOG) status information, radiosensitising conditions information, collagen vascular disease information, Non-invasive ductal carcinoma in situ information, body mass index (BMI) information, level of T-Cells in a body information, pregnancy status information, suitability of surgery information, and positron emission tomography (PET) staging information.
The patient information module 810 is configured to access patient records for a given patient. For example, the patient information module 810 can access EMR information stored in the database 124 and imaging information stored in the medical images 146. The patient information module 810 can also access a questionnaire filled out by the given patient (or provider/physician) to determine additional more recent information about the given patient than what is stored in the database 124. The patient information module 810 can detect differences between data input in the questionnaire and the data stored in the database 124. The patient information module 810 can update the data stored in the database 124 for the given patient with the more recent data input in the questionnaire. The patient information module 810 can receive input from a provider or physician including health related information about the given patient. For example, while the given patient is seeing the provider or physician, the provider or physician can directly input information provided by the patient using a user interface to the patient information module 810. In some cases, the patient information module 810 includes a voice recognition system or speech detection system and can automatically populate information for the given patient based on speech input received from the given patient.
The patient information module 810 can also access one or more image features, one or more features derived from an image and clinical data. The one or more image features can include a size, volume, or intensity of a region of interest, such as a prostate. The one or more features derived from an image can include radiomics features including texture and gradients of the one or more image features. The clinical data can include staging, genomics, and/or one or more tumor specific features, such as: a Gleason score, or a prostate-specific antigen (PSA) score.
After collecting all the information about the given patient, the patient information module 810 generates a first portion of multi-parametric input data. The patient information module 810 can access governmental body information or professional body information about various diseases, including reimbursement information and outcome metrics for different modes of treatments for the various diseases. This information can be accessed over the Internet or from a dedicated source. For example, the patient information module 810 can access one or more outcome metrics, such as: toxicities, disease-free survival information for previous patients with the disease, or reimbursement information for a plurality of different treatment modalities. For example, the multi-parametric input data can include a table or list of diseases along with their respective survival rates for different treatment modalities. The patient information module 810 can also access such information on a geographical region basis. Namely, the patient information module 810 can associate some or all of the information about the outcome metrics and reimbursement with different geographical regions. The patient information module 810 can generate a second portion of the multi-parametric input data using the governmental body information or professional body information about various diseases, including reimbursement information and outcome metrics for different modes of treatments for the various diseases.
The patient information module 810 provides the first and second portions of the multi-parametric input data to the treatment modality selection module 820. In some cases, the treatment modality selection module 820 presents a user interface to the provider/physician to select a given disease from a list of possible diseases that infect or are associated with the given patient. The treatment modality selection module 820 processes the multi-parametric input data received from the patient information module 810 using a given model. For example, the treatment modality selection module 820 implements a model 900 (
For example, each treatment processing modules 920 is configured to process the same set of multi-parametric input data 910 using a different set of rules. In some cases, each treatment processing modules 920 receives a different subset of the set of multi-parametric input data 910 with the information pertinent to the given treatment processing modules 920. For example, one of treatment processing modules 920 can process the set of multi-parametric input data 910 independently of reimbursement information for the given disease while another processes the set of multi-parametric input data 910 inclusive of the reimbursement information for the given disease. In such cases, the set of multi-parametric input data 910 supplied to one of the treatment processing modules 920 can include the reimbursement information and that supplied to another may exclude the reimbursement information.
Each of the treatment processing modules 920 can be associated with a different weight, such that the output of the treatment modality of the given treatment processing module 920 is weighted by the respective weight of the treatment processing module 920. For example, a first of the treatment processing modules 920 is configured to process the multi-parametric input data 910 using a machine learning technique to estimate one or more treatment modality. The first treatment processing module 920 is associated with a weight of 0.9 which can be used as an adjustment factor for each of the estimated one or more treatment modalities. As another example, a second of the treatment processing modules 920 is configured to process the multi-parametric input data 910 using a look-up table. The look-up table can be provided by a governmental body or professional body that associates different patient information and different diseases with respective treatment modalities. The second treatment processing module 920 is associated with a weight of 0.7 which can be used as an adjustment factor for each of the treatment modalities provided by the second treatment processing module 920. In this way, if the second treatment processing module 920 provides a first treatment modality and the first treatment processing module 920 provides a different second treatment modality, the output module 930 may rank the second treatment modality higher than the first treatment modality because the second treatment processing module 920 is associated with a greater weight (e.g., 0.9) than the weight (e.g., 0.7) associated with the first treatment processing module 920.
In some implementations, a third of the treatment processing modules 920 is configured to process the multi-parametric input data 910 using a reimbursement value table. The reimbursement value table can be provided by a governmental body that associates different patient information, reimbursement values, and different diseases with respective treatment modalities. The third treatment processing module 920 can select to output the treatment modality that is associated with a highest reimbursement value for the combination of patient information and disease. The third treatment processing module 920 is associated with a weight of 0.8 which can be used as an adjustment factor for each of the treatment modalities provided by the third treatment processing module 920.
In one example, the output module 930 of the treatment modality selection module is presented on a graphical user interface. The graphical user interface provides the ranked list of the different treatment modalities for treating the given disease. The graphical user interface visually identifies the top ranked or recommended treatment modality. The treatment modality selection module 820 receives user input from the provider or physician via the graphical user interface that selects a given treatment modality from the ranked list of treatment modalities. In some cases, the treatment modality selection module 820 stores an indication that the selected treatment modality is not the highest ranked treatment modality in response to detecting that the treatment modality selected by the user input is not the recommended treatment modality generated by the treatment modality selection module 820.
The selected treatment modality is provided to the treatment modality template selection module 830. The treatment modality template selection module 830 also receives at least a portion of the multi-parametric data from the patient information module 810. The treatment modality template selection module 830 retrieves a blank or partially filled template associated with the selected treatment modality. The treatment modality template selection module 830 automatically populates the template with the information received from the patient information module 810 and/or additional inputs received from the provider/physician. For example, the treatment modality template selection module 830 can select a radiotherapy treatment template in response to determining that the selected treatment modality includes radiotherapy. An example radiotherapy treatment template is shown in
The treatment modality template selection module 830 transmits the completed treatment modality template to the corresponding treatment execution module. For example, if the treatment modality template corresponds to radiotherapy, the treatment modality template selection module 830 transmits the completed treatment modality template to the radiotherapy treatment plan generation module 840. The radiotherapy treatment plan generation module 840 can apply various heuristics and machine learning techniques to automatically generate a radiotherapy treatment plan that includes radiotherapy device parameters (e.g., number of fractions, segmentations, dose maps, and so forth) for executing the radiotherapy treatment plan. As another example, if the treatment modality template corresponds to surgery, the treatment modality template selection module 830 transmits the completed treatment modality template to the surgical, chemotherapy, immunotherapy, targeted therapy, hormone therapy, stem cell transplant, and/or precision medicine plan generation module 842. Module 842 can apply various heuristics and machine learning techniques to automatically generate a surgical plan for executing the surgical treatment plan. As another example, if the treatment modality template corresponds to any other type of treatment modality that may not be included in the module 842 (e.g., chemotherapy, immunotherapy, targeted therapy, hormone therapy, a stem cell transplant, precision medicine, any combination of surgery, radiotherapy, chemotherapy, immunotherapy, targeted therapy, hormone therapy, a stem cell transplant, precision medicine, and preventing performance of any treatment), the treatment modality template selection module 830 transmits the completed treatment modality template to the treatment plan execution module 844. The treatment plan execution module 844 can apply various heuristics and machine learning techniques to automatically generate a treatment plan for executing the type of treatment specified by the treatment modality template.
At operation 1110, treatment modality selection device 150 receives training data. For example, image processing device 112 receives training data, which may include paired training data sets (e.g., input-output training pairs).
At operation 1120, treatment modality selection device 150 receives one or more cost functions for training the model.
At operation 1130, treatment modality selection device 150 performs training of the model based on the received training data and one or more cost functions.
At operation 1150, treatment modality selection device 150 outputs the trained model. For example, treatment modality selection device 150 outputs the trained model to operate on a new set of multi-parametric input data to generate one or more modalities for treating a disease.
At operation 1160, treatment modality selection device 150 utilizes the trained model to generate one or more modalities for treating a disease.
At operation 1210, treatment modality selection device 150 receives multi-parametric input data representing data associated with a patient, as discussed above.
At operation 1220, treatment modality selection device 150 receives an indication of a disease associated with the patient, as discussed above.
At operation 1230, treatment modality selection device 150 processes the multi-parametric input data to generate one or more metrics corresponding to a plurality of different modalities for treating the disease associated with the patient, as discussed above.
At operation 1240, treatment modality selection device 150 selects, based on the one or more metrics, a given modality from the plurality of different modalities to treat the disease associated with the patient; as discussed above.
At operation 1250, treatment modality selection device 150 configures parameters of the given modality based on a portion of the multi-parametric input data, as discussed above.
The example machine 1300 includes processor 1302 (e.g., a CPU, a GPU, an ASIC, circuitry, such as one or more transistors, resistors, capacitors, inductors, diodes, logic gates, multiplexers, buffers, modulators, demodulators, radios (e.g., transmit or receive radios or transceivers), sensors 1321 (e.g., a transducer that converts one form of energy (e.g., light, heat, electrical, mechanical, or other energy) to another form of energy), or the like, or a combination thereof), a main memory 1304 and a static memory 1306, which communicate with each other via a bus 1308. The machine 1300 (e.g., computer system) may further include a video display unit 1310 (e.g., a liquid crystal display (LCD) or a cathode ray tube (CRT)) The machine 1300 also includes an alphanumeric input device 1312 (e.g., a keyboard), a user interface (UI) navigation device 1314 (e.g., a mouse), a disk drive or mass storage unit 1316, a signal generation device 1318 (e.g., a speaker), and a network interface device 1320.
The disk drive or mass storage unit 1316 includes a machine-readable medium 1322 on which is stored one or more sets of instructions and data structures (e.g., software) 1324 embodying or utilized by any one or more of the methodologies or functions described herein. The instructions 1324 may also reside, completely or at least partially, within the main memory 1304 and/or within the processor 1302 during execution thereof by the machine 1300, the main memory 1304 and the processor 1302 also constituting machine-readable media.
The machine 1300 as illustrated includes an output controller 1328. The output controller 1328 manages data flow to/from the machine 1300. The output controller 1328 is sometimes called a device controller, with software that directly interacts with the output controller 1328 being called a device driver.
While the machine-readable medium 1322 is shown in an embodiment to be a single medium, the term “machine-readable medium” may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) that store the one or more instructions or data structures. The term “machine-readable medium” shall also be taken to include any tangible medium that is capable of storing, encoding or carrying instructions for execution by the machine and that cause the machine to perform any one or more of the methodologies of the present disclosure, or that is capable of storing, encoding or carrying data structures utilized by or associated with such instructions. The term “machine-readable medium” shall accordingly be taken to include, but not be limited to, solid-state memories, and optical and magnetic media. Specific examples of machine-readable media include non-volatile memory, including by way of example semiconductor memory devices, e.g., Erasable Programmable Read-Only Memory (EPROM), EEPROM, and flash memory devices, magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.
The instructions 1324 may further be transmitted or received over a communications network 1326 using a transmission medium. The instructions 1324 may be transmitted using the network interface device 1320 and any one of a number of well-known transfer protocols (e.g., HTTP). Examples of communication networks include a LAN, a WAN, the Internet, mobile telephone networks, Plain Old Telephone (POTS) networks, and wireless data networks (e.g., WiFi and WiMax networks). The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine, and includes digital or analog communications signals or other intangible media to facilitate communication of such software.
As used herein, “communicatively coupled between” means that the entities on either of the coupling must communicate through an item therebetween and that those entities cannot communicate with each other without communicating through the item.
The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration but not by way of limitation, specific embodiments in which the disclosure can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.
All publications, patents, and patent documents referred to in this document are incorporated by reference herein in their entirety, as though individually incorporated by reference. In the event of inconsistent usages between this document and those documents so incorporated by reference, the usage in the incorporated reference(s) should be considered supplementary to that of this document; for irreconcilable inconsistencies, the usage in this document controls.
In this document, the terms “a,” “an,” “the,” and “said” are used when introducing elements of aspects of the disclosure or in the embodiments thereof, as is common in patent documents, to include one or more than one of the elements, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated.
In the appended claims, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “comprising,” “including,” and “having” are intended to be open-ended to mean that there may be additional elements other than the listed elements, such that elements after such a term (e.g., comprising, including, having) in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” and so forth, are used merely as labels, and are not intended to impose numerical requirements on their objects.
Embodiments of the disclosure may be implemented with computer-executable instructions. The computer-executable instructions (e.g., software code) may be organized into one or more computer-executable components or modules. Aspects of the disclosure may be implemented with any number and organization of such components or modules. For example, aspects of the disclosure are not limited to the specific computer-executable instructions or the specific components or modules illustrated in the figures and described herein. Other embodiments of the disclosure may include different computer-executable instructions or components having more or less functionality than illustrated and described herein.
Method examples (e.g., operations and functions) described herein can be machine or computer-implemented at least in part (e.g., implemented as software code or instructions). Some examples can include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform methods as described in the above examples. An implementation of such methods can include software code, such as microcode, assembly language code, a higher-level language code, or the like (e.g., “source code”). Such software code can include computer readable instructions for performing various methods (e.g., “object” or “executable code”). The software code may form portions of computer program products. Software implementations of the embodiments described herein may be provided via an article of manufacture with the code or instructions stored thereon, or via a method of operating a communication interface to send data via a communication interface (e.g., wirelessly, over the internet, via satellite communications, and the like).
Further, the software code may be tangibly stored on one or more volatile or non-volatile computer-readable storage media during execution or at other times. These computer-readable storage media may include any mechanism that stores information in a form accessible by a machine (e.g., computing device, electronic system, and the like), such as, but not limited to, floppy disks, hard disks, removable magnetic disks, any form of magnetic disk storage media, CD-ROMS, magnetic-optical disks, removable optical disks (e.g., compact disks and digital video disks), flash memory devices, magnetic cassettes, memory cards or sticks (e.g., secure digital cards), RAMs (e.g., CMOS RAM and the like), recordable/non-recordable media (e.g., ROMs), EPROMS, EEPROMS, or any type of media suitable for storing electronic instructions, and the like. Such computer-readable storage medium may be coupled to a computer system bus to be accessible by the processor and other parts of the OIS.
In an embodiment, the computer-readable storage medium may have encoded a data structure for a treatment planning, wherein the treatment plan may be adaptive. The data structure for the computer-readable storage medium may be at least one of a Digital Imaging and Communications in Medicine (DICOM) format, an extended DICOM format, an XML format, and the like. DICOM is an international communications standard that defines the format used to transfer medical image-related data between various types of medical equipment. DICOM RT refers to the communication standards that are specific to radiation therapy.
In various embodiments of the disclosure, the method of creating a component or module can be implemented in software, hardware, or a combination thereof. The methods provided by various embodiments of the present disclosure, for example, can be implemented in software by using standard programming languages such as, for example, Compute Unified Device Architecture (CUDA), C, C++, Java, Python, and the like; and using standard machine learning/deep learning library (or API), such as tensorflow, torch and the like; and combinations thereof. As used herein, the terms “software” and “firmware” are interchangeable, and include any computer program stored in memory for execution by a computer.
A communication interface includes any mechanism that interfaces to any of a hardwired, wireless, optical, and the like, medium to communicate to another device, such as a memory bus interface, a processor bus interface, an Internet connection, a disk controller, and the like. The communication interface can be configured by providing configuration parameters and/or sending signals to prepare the communication interface to provide a data signal describing the software content. The communication interface can be accessed via one or more commands or signals sent to the communication interface.
The present disclosure also relates to a system for performing the operations herein. This system may be specially constructed for the required purposes, or it may comprise a general-purpose computer selectively activated or reconfigured by a computer program stored in the computer. The order of execution or performance of the operations in embodiments of the disclosure illustrated and described herein is not essential, unless otherwise specified. That is, the operations may be performed in any order, unless otherwise specified, and embodiments of the disclosure may include additional or fewer operations than those disclosed herein. For example, it is contemplated that executing or performing a particular operation before, contemporaneously with, or after another operation is within the scope of aspects of the disclosure.
In view of the above, it will be seen that the several objects of the disclosure are achieved, and other advantageous results attained. Having described aspects of the disclosure in detail, it will be apparent that modifications and variations are possible without departing from the scope of aspects of the disclosure as defined in the appended claims. As various changes could be made in the above constructions, products, and methods without departing from the scope of aspects of the disclosure, it is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the disclosure without departing from its scope. While the dimensions, types of materials and coatings described herein are intended to define the parameters of the disclosure, they are by no means limiting and are example embodiments. Many other embodiments will be apparent to those of skill in the art upon reviewing the above description. The scope of the disclosure should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment. The scope of the disclosure should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. Further, the limitations of the following claims are not written in means-plus-function format and are not intended to be interpreted based on 35 U.S.C. § 112, sixth paragraph, unless and until such claim limitations expressly use the phrase “means for” followed by a statement of function void of further structure.
The Abstract is provided to comply with 37 C.F.R. § 1.72 (b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims.
This international application claims the benefit of priority of U.S. Application Ser. No. 63/202,235, filed Jun. 2, 2021, which is hereby incorporated by reference in its entirety.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2022/072587 | 5/26/2022 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63202235 | Jun 2021 | US |
