Decision support systems in oncology: Are we there yet?

This paper presents the experience of the Kasimir project in the domain on decision knowledge management in oncology and, more broadly, a discussion about decision support systems dedicated to oncology

Modeling adaptation of breast cancer treatment decision protocols in the Kasimir project

International audienceMedical decision protocols constitute theories for healthcare decision making that are applicable for "standard" medical cases but have to be adapted for the other cases. his holds in particular for the breast cancer treatment protocol, that is one of the protocols studied in the \kasimir research project. Protocol adaptations can be seen as knowledge-intensive case-based decision support processes. Some examples of adaptations that have been performed by oncologists are presented in this paper. Several issues are then identified that need to be addressed while trying to model such processes, namely: the complexity of adaptations, the lack of relevant information about the patient, the necessity to take into account the applicability and the consequences of a decision, the closeness to decision thresholds, and the necessity to consider some patients according to different viewpoints. As handling these issues requires some additional knowledge, which has to be acquired, different methods are presented that perform adaptation knowledge acquisition either from experts, or in a semi-automatic manner. A discussion and a conclusion end the paper

A novel combination of Cased-Based Reasoning and Multi Criteria Decision Making approach to radiotherapy dose planning

In this thesis, a set of novel approaches has been developed by integration of Cased-Based Reasoning (CBR) and Multi-Criteria Decision Making (MCDM) techniques. Its purpose is to design a support system to assist oncologists with decision making about the dose planning for radiotherapy treatment with a focus on radiotherapy for prostate cancer. CBR, an artificial intelligence approach, is a general paradigm to reasoning from past experiences. It retrieves previous cases similar to a new case and exploits the successful past solutions to provide a suggested solution for the new case. The case pool used in this research is a dataset consisting of features and details related to successfully treated patients in Nottingham University Hospital. In a typical run of prostate cancer radiotherapy simple CBR, a new case is selected and thereafter based on the features available at our data set the most similar case to the new case is obtained and its solution is prescribed to the new case. However, there are a number of deficiencies associated with this approach. Firstly, in a real-life scenario, the medical team considers multiple factors rather than just the similarity between two cases and not always the most similar case provides with the most appropriate solution. Thus, in this thesis, the cases with high similarity to a new case have been evaluated with the application of the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). This approach takes into account multiple criteria besides similarity to prescribe a final solution. Moreover, the obtained dose plans were optimised through a Goal Programming mathematical model to improve the results. By incorporating oncologists’ experiences about violating the conventionally available dose limits a system was devised to manage the trade-off between treatment risk for sensitive organs and necessary actions to effectively eradicate cancer cells. Additionally, the success rate of the treatment, the 2-years cancer free possibility, has a vital role in the efficiency of the prescribed solutions. To consider the success rate, as well as uncertainty involved in human judgment about the values of different features of radiotherapy Data Envelopment Analysis (DEA) based on grey numbers, was used to assess the efficiency of different treatment plans on an input and output based approach. In order to deal with limitations involved in DEA regarding the number of inputs and outputs, we presented an approach for Factor Analysis based on Principal Components to utilize the grey numbers. Finally, to improve the CBR base of the system, we applied Grey Relational Analysis and Gaussian distant based CBR along with features weight selection through Genetic Algorithm to better handle the non-linearity exists within the problem features and the high number of features. Finally, the efficiency of each system has been validated through leave-one-out strategy and the real dataset. The results demonstrated the efficiency of the proposed approaches and capability of the system to assist the medical planning team. Furthermore, the integrated approaches developed within this thesis can be also applied to solve other real-life problems in various domains other than healthcare such as supply chain management, manufacturing, business success prediction and performance evaluation