A novel case-based reasoning approach to radiotherapy dose planning

In this thesis, novel Case-Based Reasoning (CBR) methods were developed to be included in CBRDP (Case-Based Reasoning Dose Planner) -an adaptive decision support system for radiotherapy dose planning. CBR is an artificial intelligence methodology which solves new problems by retrieving solutions to previously solved similar problems stored in a case base. The focus of this research is on dose planning for prostate cancer patients. The records of patients successfully treated in the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK, were stored in a case base and were exploited using case-based reasoning for future decision making. After each successful run of the system, a group based Simulated Annealing (SA) algorithm automatically searches for an optimal/near optimal combination of feature weights to be used in the future retrieval process of CBR. A number of research issues associated with the prostate cancer dose planning problem and the use of CBR are addressed including: (a) trade-off between the benefit of delivering a higher dose of radiation to cancer cells and the risk to damage surrounding organs, (b) deciding when and how much to violate the limitations of dose limits imposed to surrounding organs, (c) fusion of knowledge and experience gained over time in treating patients similar to the new one, (d) incorporation of the 5 years Progression Free Probability and success rate in the decision making process and (e) hybridisation of CBR with a novel group based simulated annealing algorithm to update knowledge/experience gained in treating patients over time. The efficiency of the proposed system was validated using real data sets collected from the Nottingham University Hospitals. Experiments based on a leave-one-out strategy demonstrated that for most of the patients, the dose plans generated by our approach are coherent with the dose plans prescribed by an experienced oncologist or even better. This system may play a vital role to assist the oncologist in making a better decision in less time; it incorporates the success rate of previously treated similar patients in the dose planning for a new patient and it can also be used in teaching and training processes. In addition, the developed method is generic in nature and can be used to solve similar non-linear real world complex problems

Clinical evaluation of a novel adaptive bolus calculator and safety system in Type 1 diabetes

Bolus calculators are considered state-of-the-art for insulin dosing decision support for people with Type 1 diabetes (T1D). However, they all lack the ability to automatically adapt in real-time to respond to an individual’s needs or changes in insulin sensitivity. A novel insulin recommender system based on artificial intelligence has been developed to provide personalised bolus advice, namely the Patient Empowerment through Predictive Personalised Decision Support (PEPPER) system. Besides adaptive bolus advice, the decision support system is coupled with a safety system which includes alarms, predictive glucose alerts, predictive low glucose suspend for insulin pump users, personalised carbohydrate recommendations and dynamic bolus insulin constraint. This thesis outlines the clinical evaluation of the PEPPER system in adults with T1D on multiple daily injections (MDI) and insulin pump therapy. The hypothesis was that the PEPPER system is safe, feasible and effective for use in people with TID using MDI or pump therapy. Safety and feasibility of the safety system was initially evaluated in the first phase, with the second phase evaluating feasibility of the complete system (safety system and adaptive bolus advisor). Finally, the whole system was clinically evaluated in a randomised crossover trial with 58 participants. No significant differences were observed for percentage times in range between the PEPPER and Control groups. For quality of life, participants reported higher perceived hypoglycaemia with the PEPPER system despite no objective difference in time spent in hypoglycaemia. Overall, the studies demonstrated that the PEPPER system is safe and feasible for use when compared to conventional therapy (continuous glucose monitoring and standard bolus calculator). Further studies are required to confirm overall effectiveness.Open Acces

A multi-modal reasoning methodology for managing IDDM patients

We present a knowledge management and decision support methodology for insulin dependent diabetes mellitus (IDDM) patients care. Such methodology exploits the integration of case based reasoning (CBR) and rule based reasoning (RBR), with the aim of helping physicians during therapy planning, by overcoming the intrinsic limitations shown by the independent application of the two reasoning paradigms. RBR provides suggestions on the basis of a situation detection mechanism that relies on formalized prior knowledge; CBR is used to specialize and dynamically adapt the rules on the basis of the patient\u2019s characteristics and of the accumulated experience. When the case library is not representative of the overall population, only RBR is applied to define a therapy for the input situation, which can then be retained, enriching the case library competence. The paper reports the first evaluation results, obtained both on simulated examples and on real patients. This work was developed within the EU funded telematic management of insulin dependent diabetes mellitus (T-IDDM) project, and is fully integrated in its web-based architecture

A Multi-Modal Reasoning Methodology for Managing IDDM Patients

We present a knowledge management and decision support methodology for insulin dependent diabetes mellitus (IDDM) patients care. Such methodology exploits the integration of case based reasoning (CBR) and rule based reasoning (RBR), with the aim of helping physicians during therapy planning, by overcoming the intrinsic limitations shown by the independent application of the two reasoning paradigms. RBR provides suggestions on the basis of a situation detection mechanism that relies on formalized prior knowledge; CBR is used to specialize and dynamically adapt the rules on the basis of the patient's characteristics and of the accumulated experience. When the case library is not representative of the overall population, only RBR is applied to define a therapy for the input situation, which can then be retained, enriching the case library competence. The paper reports the first evaluation results, obtained both on simulated examples and on real patients. This work was developed within the EU funded telematic management of insulin dependent diabetes mellitus (T-IDDM) project, and is fully integrated in its web-based architecture

A novel case-based reasoning approach to radiotherapy dose planning

In this thesis, novel Case-Based Reasoning (CBR) methods were developed to be included in CBRDP (Case-Based Reasoning Dose Planner) -an adaptive decision support system for radiotherapy dose planning. CBR is an artificial intelligence methodology which solves new problems by retrieving solutions to previously solved similar problems stored in a case base. The focus of this research is on dose planning for prostate cancer patients. The records of patients successfully treated in the Nottingham University Hospitals NHS Trust, City Hospital Campus, UK, were stored in a case base and were exploited using case-based reasoning for future decision making. After each successful run of the system, a group based Simulated Annealing (SA) algorithm automatically searches for an optimal/near optimal combination of feature weights to be used in the future retrieval process of CBR. A number of research issues associated with the prostate cancer dose planning problem and the use of CBR are addressed including: (a) trade-off between the benefit of delivering a higher dose of radiation to cancer cells and the risk to damage surrounding organs, (b) deciding when and how much to violate the limitations of dose limits imposed to surrounding organs, (c) fusion of knowledge and experience gained over time in treating patients similar to the new one, (d) incorporation of the 5 years Progression Free Probability and success rate in the decision making process and (e) hybridisation of CBR with a novel group based simulated annealing algorithm to update knowledge/experience gained in treating patients over time. The efficiency of the proposed system was validated using real data sets collected from the Nottingham University Hospitals. Experiments based on a leave-one-out strategy demonstrated that for most of the patients, the dose plans generated by our approach are coherent with the dose plans prescribed by an experienced oncologist or even better. This system may play a vital role to assist the oncologist in making a better decision in less time; it incorporates the success rate of previously treated similar patients in the dose planning for a new patient and it can also be used in teaching and training processes. In addition, the developed method is generic in nature and can be used to solve similar non-linear real world complex problems