Retrospective Comparative Analysis of Prostate Cancer In-Basket Messages: Responses from Closed-Domain LLM vs. Clinical Teams

In-basket message interactions play a crucial role in physician-patient communication, occurring during all phases (pre-, during, and post) of a patient's care journey. However, responding to these patients' inquiries has become a significant burden on healthcare workflows, consuming considerable time for clinical care teams. To address this, we introduce RadOnc-GPT, a specialized Large Language Model (LLM) powered by GPT-4 that has been designed with a focus on radiotherapeutic treatment of prostate cancer with advanced prompt engineering, and specifically designed to assist in generating responses. We integrated RadOnc-GPT with patient electronic health records (EHR) from both the hospital-wide EHR database and an internal, radiation-oncology-specific database. RadOnc-GPT was evaluated on 158 previously recorded in-basket message interactions. Quantitative natural language processing (NLP) analysis and two grading studies with clinicians and nurses were used to assess RadOnc-GPT's responses. Our findings indicate that RadOnc-GPT slightly outperformed the clinical care team in "Clarity" and "Empathy," while achieving comparable scores in "Completeness" and "Correctness." RadOnc-GPT is estimated to save 5.2 minutes per message for nurses and 2.4 minutes for clinicians, from reading the inquiry to sending the response. Employing RadOnc-GPT for in-basket message draft generation has the potential to alleviate the workload of clinical care teams and reduce healthcare costs by producing high-quality, timely responses.

Noisy probing dose facilitated dose prediction for pencil beam scanning proton therapy: physics enhances generalizability

Purpose: Prior AI-based dose prediction studies in photon and proton therapy often neglect underlying physics, limiting their generalizability to handle outlier clinical cases, especially for pencil beam scanning proton therapy (PBSPT). Our aim is to design a physics-aware and generalizable AI-based PBSPT dose prediction method that has the underlying physics considered to achieve high generalizability to properly handle the outlier clinical cases. Methods and Materials: This study analyzed PBSPT plans of 103 prostate and 78 lung cancer patients from our institution,with each case comprising CT images, structure sets, and plan doses from our Monte-Carlo dose engine (serving as the ground truth). Three methods were evaluated in the ablation study: the ROI-based method, the beam mask and sliding window method, and the noisy probing dose method. Twelve cases with uncommon beam angles or prescription doses tested the methods' generalizability to rare treatment planning scenarios. Performance evaluation used DVH indices, 3D Gamma passing rates (3%/2mm/10%), and dice coefficients for dose agreement. Results: The noisy probing dose method showed improved agreement of DVH indices, 3D Gamma passing rates, and dice coefficients compared to the conventional methods for the testing cases. The noisy probing dose method showed better generalizability in the 6 outlier cases than the ROI-based and beam mask-based methods with 3D Gamma passing rates (for prostate cancer, targets: 89.32%$\pm$1.45% vs. 93.48%$\pm$1.51% vs. 96.79%$\pm$0.83%, OARs: 85.87%$\pm$1.73% vs. 91.15%$\pm$1.13% vs. 94.29%$\pm$1.01%). The dose predictions were completed within 0.3 seconds. Conclusions: We've devised a novel noisy probing dose method for PBSPT dose prediction in prostate and lung cancer patients. With more physics included, it enhances the generalizability of dose prediction in handling outlier clinical cases.