用强化学习自动规划前列腺癌冷冻消融,提升精准度与效率
Cryo-RL: automating prostate cancer cryoablation planning with reinforcement learning
- 将冷冻消融规划建模为马尔可夫决策过程,通过强化学习自动优化探针位置
- 在583例病例中比最优自动化方法提升8个百分点以上Dice分数,媲美专家水平
- 适合临床医生快速生成标准化治疗方案,降低对经验依赖
冷冻消融是一种微创局部治疗前列腺癌的方法,在解冻过程中破坏癌变组织,同时保护周围健康结构。其疗效取决于术前探针位置的精确规划,以完全覆盖肿瘤并避开重要解剖结构。当前规划依赖人工,需专业知识且耗时,导致治疗质量不一、难以规模化。本文提出Cryo-RL,一种基于强化学习的框架,将冷冻消融规划建模为马尔可夫决策过程,代理在模拟环境中依次选择探针位置与冰球直径,依据基于肿瘤覆盖度的奖励函数学习最优策略。无需人工设计计划,即可生成高效探针布局。在583例回顾性前列腺癌病例上评估,相比最优几何优化自动化方法,Dice分数提升超8个百分点,达到人类专家水平,同时大幅减少规划时间。结果表明强化学习可实现临床可行、可复现且高效的冷冻消融规划。
原文摘要 · Abstract (English)
Cryoablation is a minimally invasive localised treatment for prostate cancer that destroys malignant tissue during de-freezing, while sparing surrounding healthy structures. Its success depends on accurate preoperative planning of cryoprobe placements to fully cover the tumour and avoid critical anatomy. This planning is currently manual, expertise-dependent, and time-consuming, leading to variability in treatment quality and limited scalability. In this work, we introduce Cryo-RL, a reinforcement learning framework that models cryoablation planning as a Markov decision process and learns an optimal policy for cryoprobe placement. Within a simulated environment that models clinical constraints and stochastic intraoperative variability, an agent sequentially selects cryoprobe positions and ice sphere diameters. Guided by a reward function based on tumour coverage, this agent learns a cryoablation strategy that leads to optimal cryoprobe placements without the need for any manually-designed plans. Evaluated on 583 retrospective prostate cancer cases, Cryo-RL achieved over 8 percentage-point Dice improvements compared with the best automated baselines, based on geometric optimisation, and matched human expert performance while requiring substantially less planning time. These results highlight the potential of reinforcement learning to deliver clinically viable, reproducible, and efficient cryoablation plans.
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