An integrated two-level hierarchical system for decision making in radiation therapy based on fuzzy cognitive maps

Radiation therapy decision-making is a complex process that has to take into consideration a variety of interrelated functions. Many fuzzy factors that must be considered in the calculation of the appropriate dose increase the complexity of the decision-making problem. A novel approach introduces fuzzy cognitive maps (FCMs) as the computational modeling method, which tackles the complexity and allows the analysis and simulation of the clinical radiation procedure. Specifically this approach is used to determine the success of radiation therapy process estimating the final dose delivered to the target volume, based on the soft computing technique of FCMs. Furthermore a two-level integrated hierarchical structure is proposed to supervise and evaluate the radiotherapy process prior to treatment execution. The supervisor determines the treatment variables of cancer therapy and the acceptance level of final radiation dose to the target volume. Two clinical case studies are used to test the proposed methodology and evaluate the simulation results. The usefulness of this two-level hierarchical structure discussed and future research directions are suggested for the clinical use of this methodology.