Application of

Artificial
Intelligence (AI)
in Radiotherapy
Noor Naslinda Noor Rizan, BBMed, MSc
Consultant Medical Physicist
Outline
• General Artificial Intelligence (AI) definition and application
• Terminology
• ChatGPT and Bard
• AI in Radiotherapy
• Demo of AI on MIMs
AI in General : ChatGPT vs Bard AI
ChatGPT
• Created by OpenAI
• Python scripting
• Stop learning in 2022 (no latest input) start to learn from internet
again in Oct 2023)
• Bogus citation

Bard
• Created by Google
• Latest input from Google search engine dan database
Artificial Intelligence VS Automation

AI Automation
Definition Artificial intelligence is the ability of a machine to perform tasks that Automation is the use of technology to perform tasks
normally require human intelligence, such as learning, reasoning, and automatically without human intervention.
problem-solving.

Level of decision making can make decisions based on their learning and understanding of the typically follow pre-programmed rules and instructions.
world.

Ability to learn and adapt can learn from data and adapt their behaviour over time do not learn or adapt

Complexity of tasks can be used to perform complex tasks that require human-like used to perform repetitive and routine tasks, such as
intelligence, such as medical diagnosis, fraud detection, and natural assembling products, sending emails, and processing data
language processing

Examples Self-driving cars, virtual assistants, medical diagnostic systems, product Robotic assembly lines, automatic billing systems, software
recommendation systems, machine translation bots
 AI Terminology
• Algorithm - A set of instructions that a computer follows to perform a task.
• Artificial neural network - A type of machine learning algorithm that is inspired by the structure and
function of the human brain.
• Big data - Large datasets that are too complex or large to be processed by traditional data processing
software.
• Deep learning - A type of machine learning that uses artificial neural networks to learn from data.
• Machine learning - A type of AI that allows computers to learn without being explicitly programmed.
• Natural language processing (NLP) - A field of AI that deals with the interaction between computers and
human language.
• Reinforcement learning - A type of machine learning that allows computers to learn by trial and error.
• Supervised learning - A type of machine learning in which the computer is trained on a set of labelled
data.
• Unsupervised learning - A type of machine learning in which the computer is trained on a set of
unlabelled data.
How to ask question (Prompt)
AI in Radiation
Oncology

Gilmer Valdes, Lei Xing - Artificial

Intelligence in Radiation Oncology and
Biomedical Physics (2023)

Book outline:
Integration of AI in Clinical Radiation Oncology
One question we ask ourselves is: How can
we optimize and speed up the entire
radiation therapy planning and delivery
workflow – with the help of AI?

AI is a tool. If we use it in the right ways, it has

the potential to make life easier for all of us.
Yet, the changes that it unleashes are rapid and
far-reaching. This puts a huge responsibility on
us as a medical technology company.
-Fernando Vega
Head of Software & Concept Definition Cancer
Therapy Imaging
Siemens Healthineers
Treatment planning optimization

• Time consuming task

• Involves a team of highly trained staff
• From simulation to CT to plan approval ~ 5
working day
• Human are humans (we are quite bad at
making complex unaided decision)
• We use our training experience and intuition to
identify best solution
• Plan quality metric
 A - Workflow of manual treatment planning

B - Workflow of Automated Rule Implementation and

Reasoning (ARIR) in treatment planning (Pinacle
Autoplan) – planning template with sets up specific
requirement – TPS will fine tune the plan

C- Workflow of Knowledge-based Planning (KBP) in

treatment planning (Varian Rapidplan) – extract features
from good cases and use it to develop new plan

D - Workflow of Multi Criteria Optimization (MCO) in

treatment planning (Raystation and Eclipse) - generation
of many plans to form the Pareto surface

E - workflow of AI use in future treatment planning

[1]Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future
Chunhao Wang et al.
Raysearch Laboratory AI for treatment planning

Case study Princess Margaret Cancer Centre

• AI planning system developed by Drs. Purdie and McIntosh dramatically reduces the time and associated costs required to
generate radiation treatments

• It can create a high-quality treatment plans in just minutes. The system uses AI that compares patients’ medical images with
a database of previously high-quality treatment plans created by experts at Princess Margaret.

• found that AI treatment plans were preferred or found equivalent to human-generated treatment plans that had been used for
patient care in 88% of cases according to a panel of clinical experts.
Image segmentation and contouring

• Contour ProtégéAI (MIM Software)

• Contour+ (MVision AI)
• AI Rad Autocompanion (Siemens Healtineers)
• Velocity AI (Elekta)
• Varian AI (Varian)
Image segmentation and contouring
• Image contouring involves the process of annotating or labeling features i.e., organs and tumors) an input
image
• Traditionally, images were contoured manually by experts e.g radiation oncologists, dosimetrists, and/or
physicists
• Manual contouring suffers from being time-consuming and is susceptible to inter- and intra-user variability
that can affect subsequent dose calculations, which ultimately has the potential for poorer patient outcomes

With AI
Pros Cons
• Automatically segment and contour tumours and • Early stage adaptation, a lot more input
organs at risk on medical images needed for trustable system
• Time-consuming and challenging task for human • Need high investment in data infrastructure
experts, but AI can do it quickly and “accurately” and maintenance
(debatable)
• Clinical acceptability
• Offers automation, efficiency and consistency
• Cut the time for planning radiation therapy treatment
Contouring variety

AI and Machine Learning for Treatment Planning and Image Segmentation

Carlos Cardenas, MS University of Texas MD Anderson Cancer Center
cecardenas@mdanderson.org
Adaptive Radiotherapy

Machine and deep learning models can be leveraged to reduce treatment times in
adaptive radiotherapy, such as automating treatment contouring or speeding-up dose
calculations [2]
Machine and Patient Specific QA

• Machine Learning of Machine QA

Predict Linac performance as well as discrepancies in multileaf collimator (MLC) by reviewing log files, EPID images, annual
water tank data

• Automated Chart Review

data parameters, calculation accuracy, image guidance, plan quality, and consideration of technical clinical factors
The works is repetitive and time crunching, but 33% of near miss comes from pre-treatment process

• Patient Specific QA
Machine learning can able to predict QA result based on the plan, LINAC and other input parameters
Normal PSQA involve measurement of single ion chamber measurement, diode or ion chamber array, EPID, and log files.
Data Management and Integration
Automated Documentation
Ethical Questions

• Who is responsible for AI decision?

• Medico Legal case, who is going to represent AI?
Reference:

[1] Chunhao Wang et al - Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future. Technology in Cancer
Research & Treatment Volume 18: 1-11 (2019)
[2] Gilmer Valdes, Lei Xing - Artificial Intelligence in Radiation Oncology and Biomedical Physics (2023)