32,697 research outputs found
Systems approaches and algorithms for discovery of combinatorial therapies
Effective therapy of complex diseases requires control of highly non-linear
complex networks that remain incompletely characterized. In particular, drug
intervention can be seen as control of signaling in cellular networks.
Identification of control parameters presents an extreme challenge due to the
combinatorial explosion of control possibilities in combination therapy and to
the incomplete knowledge of the systems biology of cells. In this review paper
we describe the main current and proposed approaches to the design of
combinatorial therapies, including the empirical methods used now by clinicians
and alternative approaches suggested recently by several authors. New
approaches for designing combinations arising from systems biology are
described. We discuss in special detail the design of algorithms that identify
optimal control parameters in cellular networks based on a quantitative
characterization of control landscapes, maximizing utilization of incomplete
knowledge of the state and structure of intracellular networks. The use of new
technology for high-throughput measurements is key to these new approaches to
combination therapy and essential for the characterization of control
landscapes and implementation of the algorithms. Combinatorial optimization in
medical therapy is also compared with the combinatorial optimization of
engineering and materials science and similarities and differences are
delineated.Comment: 25 page
An Automated Treatment Plan Quality Control Tool for Intensity-Modulated Radiation Therapy Using a Voxel-Weighting Factor-Based Re-Optimization Algorithm.
Intensity-modulated radiation therapy (IMRT) currently plays an important role in radiotherapy, but its treatment plan quality can vary significantly among institutions and planners. Treatment plan quality control (QC) is a necessary component for individual clinics to ensure that patients receive treatments with high therapeutic gain ratios. The voxel-weighting factor-based plan re-optimization mechanism has been proved able to explore a larger Pareto surface (solution domain) and therefore increase the possibility of finding an optimal treatment plan. In this study, we incorporated additional modules into an in-house developed voxel weighting factor-based re-optimization algorithm, which was enhanced as a highly automated and accurate IMRT plan QC tool (TPS-QC tool). After importing an under-assessment plan, the TPS-QC tool was able to generate a QC report within 2 minutes. This QC report contains the plan quality determination as well as information supporting the determination. Finally, the IMRT plan quality can be controlled by approving quality-passed plans and replacing quality-failed plans using the TPS-QC tool. The feasibility and accuracy of the proposed TPS-QC tool were evaluated using 25 clinically approved cervical cancer patient IMRT plans and 5 manually created poor-quality IMRT plans. The results showed high consistency between the QC report quality determinations and the actual plan quality. In the 25 clinically approved cases that the TPS-QC tool identified as passed, a greater difference could be observed for dosimetric endpoints for organs at risk (OAR) than for planning target volume (PTV), implying that better dose sparing could be achieved in OAR than in PTV. In addition, the dose-volume histogram (DVH) curves of the TPS-QC tool re-optimized plans satisfied the dosimetric criteria more frequently than did the under-assessment plans. In addition, the criteria for unsatisfied dosimetric endpoints in the 5 poor-quality plans could typically be satisfied when the TPS-QC tool generated re-optimized plans without sacrificing other dosimetric endpoints. In addition to its feasibility and accuracy, the proposed TPS-QC tool is also user-friendly and easy to operate, both of which are necessary characteristics for clinical use
Addressing current challenges in cancer immunotherapy with mathematical and computational modeling
The goal of cancer immunotherapy is to boost a patient's immune response to a
tumor. Yet, the design of an effective immunotherapy is complicated by various
factors, including a potentially immunosuppressive tumor microenvironment,
immune-modulating effects of conventional treatments, and therapy-related
toxicities. These complexities can be incorporated into mathematical and
computational models of cancer immunotherapy that can then be used to aid in
rational therapy design. In this review, we survey modeling approaches under
the umbrella of the major challenges facing immunotherapy development, which
encompass tumor classification, optimal treatment scheduling, and combination
therapy design. Although overlapping, each challenge has presented unique
opportunities for modelers to make contributions using analytical and numerical
analysis of model outcomes, as well as optimization algorithms. We discuss
several examples of models that have grown in complexity as more biological
information has become available, showcasing how model development is a dynamic
process interlinked with the rapid advances in tumor-immune biology. We
conclude the review with recommendations for modelers both with respect to
methodology and biological direction that might help keep modelers at the
forefront of cancer immunotherapy development.Comment: Accepted for publication in the Journal of the Royal Society
Interfac
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Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future.
Treatment planning is an essential step of the radiotherapy workflow. It has become more sophisticated over the past couple of decades with the help of computer science, enabling planners to design highly complex radiotherapy plans to minimize the normal tissue damage while persevering sufficient tumor control. As a result, treatment planning has become more labor intensive, requiring hours or even days of planner effort to optimize an individual patient case in a trial-and-error fashion. More recently, artificial intelligence has been utilized to automate and improve various aspects of medical science. For radiotherapy treatment planning, many algorithms have been developed to better support planners. These algorithms focus on automating the planning process and/or optimizing dosimetric trade-offs, and they have already made great impact on improving treatment planning efficiency and plan quality consistency. In this review, the smart planning tools in current clinical use are summarized in 3 main categories: automated rule implementation and reasoning, modeling of prior knowledge in clinical practice, and multicriteria optimization. Novel artificial intelligence-based treatment planning applications, such as deep learning-based algorithms and emerging research directions, are also reviewed. Finally, the challenges of artificial intelligence-based treatment planning are discussed for future works
Optimization of spatiotemporally fractionated radiotherapy treatments with bounds on the achievable benefit
Spatiotemporal fractionation schemes, that is, treatments delivering
different dose distributions in different fractions, may lower treatment side
effects without compromising tumor control. This is achieved by
hypofractionating parts of the tumor while delivering approximately uniformly
fractionated doses to the healthy tissue. Optimization of such treatments is
based on biologically effective dose (BED), which leads to computationally
challenging nonconvex optimization problems. Current optimization methods yield
only locally optimal plans, and it has been unclear whether these are close to
the global optimum. We present an optimization model to compute rigorous bounds
on the normal tissue BED reduction achievable by such plans.
The approach is demonstrated on liver tumors, where the primary goal is to
reduce mean liver BED without compromising other treatment objectives. First a
uniformly fractionated reference plan is computed using convex optimization.
Then a nonconvex quadratically constrained quadratic programming model is
solved to local optimality to compute a spatiotemporally fractionated plan that
minimizes mean liver BED subject to the constraints that the plan is no worse
than the reference plan with respect to all other planning goals. Finally, we
derive a convex relaxation of the second model in the form of a semidefinite
programming problem, which provides a lower bound on the lowest achievable mean
liver BED.
The method is presented on 5 cases with distinct geometries. The computed
spatiotemporal plans achieve 12-35% mean liver BED reduction over the reference
plans, which corresponds to 79-97% of the gap between the reference mean liver
BEDs and our lower bounds. This indicates that spatiotemporal treatments can
achieve substantial reduction in normal tissue BED, and that local optimization
provides plans that are close to realizing the maximum potential benefit
Accurate,robust and harmonized implementation of morpho-functional imaging in treatment planning for personalized radiotherapy
In this work we present a methodology able to use harmonized PET/CT imaging in dose painting by number (DPBN) approach by means of a robust and accurate treatment planning system. Image processing and treatment planning were performed by using a Matlab-based platform, called CARMEN, in which a full Monte Carlo simulation is included. Linear programming formulation was developed for a voxel-by-voxel robust optimization and a specific direct aperture optimization was designed for an efficient adaptive radiotherapy implementation. DPBN approach with our methodology was tested to reduce the uncertainties associated with both, the absolute value and the relative value of the information in the functional image. For the same H&N case, a single robust treatment was planned for dose prescription maps corresponding to standardized uptake value distributions from two different image reconstruction protocols: One to fulfill EARL accreditation for harmonization of [18F]FDG PET/CT image, and the other one to use the highest available spatial resolution. Also, a robust treatment was planned to fulfill dose prescription maps corresponding to both approaches, the dose painting by contour based on volumes and our voxel-by-voxel DPBN. Adaptive planning was also carried out to check the suitability of our proposal.
Different plans showed robustness to cover a range of scenarios for implementation of harmonizing strategies by using the highest available resolution. Also, robustness associated to discretization level of dose prescription according to the use of contours or numbers was achieved. All plans showed excellent quality index histogram and quality factors below 2%. Efficient solution for adaptive radiotherapy based directly on changes in functional image was obtained. We proved that by using voxel-by-voxel DPBN approach it is possible to overcome typical drawbacks linked to PET/CT images, providing to the clinical specialist confidence enough for routinely implementation of functional imaging for personalized radiotherapy.Junta de Andalucía (FISEVI, reference project CTS 2482)European Regional Development Fund (FEDER
Three-Dimensional Dose Prediction for Lung IMRT Patients with Deep Neural Networks: Robust Learning from Heterogeneous Beam Configurations
The use of neural networks to directly predict three-dimensional dose
distributions for automatic planning is becoming popular. However, the existing
methods only use patient anatomy as input and assume consistent beam
configuration for all patients in the training database. The purpose of this
work is to develop a more general model that, in addition to patient anatomy,
also considers variable beam configurations, to achieve a more comprehensive
automatic planning with a potentially easier clinical implementation, without
the need of training specific models for different beam settings
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