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Quantum gates are crucial for processing quantum information, but implementing them in a photonic platform poses unique challenges due to the peculiar way photons propagate and interfere. Here, we examine quantum photonic gates that utilize continuous time two-dimensional random walking photons. These gates can be implemented using the inverse design method, where photons randomly walk in a two-dimensional silicon host medium embedded with silicon dioxide scatterers. We propose a C-NOT gate as a multiqubit gate and an X-gate as a single qubit gate. In addition, we provide studying the non-trivial spatial correlations of random walking photons by utilizing the quantum correlation function. The results demonstrate high-fidelity probabilistic quantum gates. Further work is required to address error-correction. This work advances the practical implementation photonic elements in linear optics quantum computation schemes.

PULSAR (personalized ultrafractionated stereotactic adaptive radiotherapy) is a form of radiotherapy method where a patient is given a large dose or pulse of radiation a couple of weeks apart rather than daily small doses. The tumor response is then monitored to determine when the subsequent pulse should be given. Pre-clinical trials have shown better tumor response in mice that received immunotherapy along with pulses spaced 10 days apart. However, this was not the case when the pulses were 1 day apart. Therefore, a synergistic effect between immunotherapy and PULSAR is observed when the pulses are spaced out by a certain number of days. In our study, we aimed to develop a mathematical model that can capture the synergistic effect by considering a time-dependent weight function that takes into account the spacing between pulses. By determining feasible parameters, and applying reasonable conditions, we utilize our model to simulate murine trials with varying sequencing of pulses. We successfully demonstrate that our model is simple to implement and can generate tumor volume data that is consistent with the pre-clinical trial data. Our model has the potential to aid in the development of clinical trials of PULSAR therapy.

High-throughput computational materials discovery has promised significant acceleration of the design and discovery of new materials for many years. Despite a surge in interest and activity, the constraints imposed by large-scale computational resources present a significant bottleneck. Furthermore, examples of large-scale computational discovery carried through experimental validation remain scarce, especially for materials with product applicability. Here we demonstrate how this vision became reality by first combining state-of-the-art artificial intelligence (AI) models and traditional physics-based models on cloud high-performance computing (HPC) resources to quickly navigate through more than 32 million candidates and predict around half a million potentially stable materials. By focusing on solid-state electrolytes for battery applications, our discovery pipeline further identified 18 promising candidates with new compositions and rediscovered a decade's worth of collective knowledge in the field as a byproduct. By employing around one thousand virtual machines (VMs) in the cloud, this process took less than 80 hours. We then synthesized and experimentally characterized the structures and conductivities of our top candidates, the Na$_x$Li$_{3-x}$YCl$_6$ ($0 < x < 3$) series, demonstrating the potential of these compounds to serve as solid electrolytes. Additional candidate materials that are currently under experimental investigation could offer more examples of the computational discovery of new phases of Li- and Na-conducting solid electrolytes. We believe that this unprecedented approach of synergistically integrating AI models and cloud HPC not only accelerates materials discovery but also showcases the potency of AI-guided experimentation in unlocking transformative scientific breakthroughs with real-world applications.

Achieving effective synergy between radiotherapy and immunotherapy is critical for optimizing tumor control and treatment outcomes. To explore the underlying mechanisms of this synergy, we have investigated a novel treatment approach known as personalized ultra-fractionated stereotactic adaptive radiation therapy (PULSAR), which emphasizes the impact of radiation timing on treatment efficacy. However, the precise mechanism remains unclear. Building on insights from small animal PULSAR studies, we developed a mathematical framework consisting of multiple ordinary differential equations to elucidate the temporal dynamics of tumor control resulting from radiation and the adaptive immune response. The model accounts for the migration and infiltration of T-cells within the tumor microenvironment. This proposed model establishes a causal and quantitative link between radiation therapy and immunotherapy, providing a valuable in-silico analysis tool for designing future PULSAR trials.

Estimating the uncertainty of deep learning models in a reliable and efficient way has remained an open problem, where many different solutions have been proposed in the literature. Most common methods are based on Bayesian approximations, like Monte Carlo dropout (MCDO) or Deep ensembling (DE), but they have a high inference time (i.e. require multiple inference passes) and might not work for out-of-distribution detection (OOD) data (i.e. similar uncertainty for in-distribution (ID) and OOD). In safety critical environments, like medical applications, accurate and fast uncertainty estimation methods, able to detect OOD data, are crucial, since wrong predictions can jeopardize patients safety. In this study, we present an alternative direct uncertainty estimation method and apply it for a regression U-Net architecture. The method consists in the addition of a branch from the bottleneck which reconstructs the input. The input reconstruction error can be used as a surrogate of the model uncertainty. For the proof-of-concept, our method is applied to proton therapy dose prediction in head and neck cancer patients. Accuracy, time-gain, and OOD detection are analyzed for our method in this particular application and compared with the popular MCDO and DE. The input reconstruction method showed a higher Pearson correlation coefficient with the prediction error (0.620) than DE and MCDO (between 0.447 and 0.612). Moreover, our method allows an easier identification of OOD (Z-score of 34.05). It estimates the uncertainty simultaneously to the regression task, therefore requires less time or computational resources., Comment: 11 pages, 3 figures and 3 Tables

The thalamus and its constituent nuclei are critical for a broad range of cognitive and sensorimotor processes, and implicated in many neurological and neurodegenerative conditions. However, the functional involvement and specificity of thalamic nuclei in human neuroimaging is underappreciated and not well studied due, in part, to technical challenges of accurately identifying and segmenting nuclei. This challenge is further exacerbated by a lack of common nomenclature for comparing segmentation methods. Here, we use data from healthy young (Human Connectome Project, 100 subjects) and older healthy adults, plus those with minor cognitive impairment and Alzheimer$'$s disease (Alzheimer$'$s Disease Neuroimaging Initiative, 540 subjects), to benchmark four state of the art thalamic segmentation methods for T1 MRI (FreeSurfer, HIPS-THOMAS, SCS-CNN, and T1-THOMAS) under a single segmentation framework. Segmentations were compared using overlap and dissimilarity metrics to the Morel stereotaxic atlas. We also quantified each method$'$s estimation of thalamic nuclear degeneration across Alzheimer$'$s disease progression, and how accurately early and late mild cognitive impairment, and Alzheimers disease could be distinguished from healthy controls. We show that HIPS-THOMAS produced the most effective segmentations of individual thalamic nuclei and was also most accurate in discriminating healthy controls from those with mild cognitive impairment and Alzheimer$'$s disease using individual nucleus volumes. This work is the first to systematically compare the efficacy of anatomical thalamic segmentation approaches under a unified nomenclature. We also provide recommendations of which segmentation method to use for studying the functional relevance of specific thalamic nuclei, based on their overlap and dissimilarity with the Morel atlas., Comment: 10 figures, 4 tables, 3 supplemental figures, 2 supplemental tables

Hydrogen embrittlement mechanisms of steels have been studied for several decades. Understanding hydrogen diffusion behavior in steels is crucial towards both developing predictive models for hydrogen embrittlement and identifying mitigation strategies. However, because hydrogen has a low atomic mass, it is extremely challenging to detect by most analytical methods. In recent years, cryogenic-transfer atom probe tomography (APT) of electrochemically-deuterium-charged steels has provided invaluable qualitative analysis of nanoscale deuterium traps such as carbides, dislocations, grain boundaries and interfaces between ferrite and cementite. Independently, cyclic voltammetry (CV) has provided valuable analysis of bulk hydrogen diffusion in steels. In this work, we use a combination of CV and cryogenic-transfer APT for quantitative analysis of deuterium pickup in electrolytically charged pure Fe (ferrite) and a model austenitic Fe18Cr14Ni alloy without any second phase or defect trap sites. The high solubility and low diffusivity of hydrogen in austenite versus ferrite are highlighted to result in clear observable signatures in CV and cryogenic-transfer APT results. The remaining challenges and pathway for enabling quantitative analysis of hydrogen pick up in steels is also discussed.

Background and purpose: Radiation-induced erectile dysfunction (RiED) is commonly seen in prostate cancer patients. Clinical trials have been developed in multiple institutions to investigate whether dose-sparing to the internal-pudendal-arteries (IPA) will improve retention of sexual potency. The IPA is usually not considered a conventional organ-at-risk (OAR) due to segmentation difficulty. In this work, we propose a deep learning (DL)-based auto-segmentation model for the IPA that utilizes CT and MRI or CT alone as the input image modality to accommodate variation in clinical practice. Materials and methods: 86 patients with CT and MRI images and noisy IPA labels were recruited in this study. We split the data into 42/14/30 for model training, testing, and a clinical observer study, respectively. There were three major innovations in this model: 1) we designed an architecture with squeeze-and-excite blocks and modality attention for effective feature extraction and production of accurate segmentation, 2) a novel loss function was used for training the model effectively with noisy labels, and 3) modality dropout strategy was used for making the model capable of segmentation in the absence of MRI. Results: The DSC, ASD, and HD95 values for the test dataset were 62.2%, 2.54mm, and 7mm, respectively. AI segmented contours were dosimetrically equivalent to the expert physician's contours. The observer study showed that expert physicians' scored AI contours (mean=3.7) higher than inexperienced physicians' contours (mean=3.1). When inexperienced physicians started with AI contours, the score improved to 3.7. Conclusion: The proposed model achieved good quality IPA contours to improve uniformity of segmentation and to facilitate introduction of standardized IPA segmentation into clinical trials and practice.

When a pre-trained general auto-segmentation model is deployed at a new institution, a support framework in the proposed Prior-guided DDL network will learn the systematic difference between the model predictions and the final contours revised and approved by clinicians for an initial group of patients. The learned style feature differences are concatenated with the new patients (query) features and then decoded to get the style-adapted segmentations. The model is independent of practice styles and anatomical structures. It meta-learns with simulated style differences and does not need to be exposed to any real clinical stylized structures during training. Once trained on the simulated data, it can be deployed for clinical use to adapt to new practice styles and new anatomical structures without further training. To show the proof of concept, we tested the Prior-guided DDL network on six different practice style variations for three different anatomical structures. Pre-trained segmentation models were adapted from post-operative clinical target volume (CTV) segmentation to segment CTVstyle1, CTVstyle2, and CTVstyle3, from parotid gland segmentation to segment Parotidsuperficial, and from rectum segmentation to segment Rectumsuperior and Rectumposterior. The mode performance was quantified with Dice Similarity Coefficient (DSC). With adaptation based on only the first three patients, the average DSCs were improved from 78.6, 71.9, 63.0, 52.2, 46.3 and 69.6 to 84.4, 77.8, 73.0, 77.8, 70.5, 68.1, for CTVstyle1, CTVstyle2, and CTVstyle3, Parotidsuperficial, Rectumsuperior, and Rectumposterior, respectively, showing the great potential of the Priorguided DDL network for a fast and effortless adaptation to new practice styles

We are in a golden age of progress in artificial intelligence (AI). Radiotherapy, due to its technology-intensive nature as well as direct human-machine interactions, is perfectly suited for benefitting from AI to enhance accuracy and efficiency. Over the past few years, a vast majority of AI research have already been published in the field of photon therapy, while the applications of AI specifically targeted for particle therapy remain scarcely investigated. There are two distinct differences between photon therapy and particle therapy: beam interaction physics (photons vs. charged particles) and beam delivery mode (e.g. IMRT/VMAT vs. pencil beam scanning). As a result, different strategies of AI deployment are required between these two radiotherapy modalities. In this article, we aim to present a comprehensive survey of recent literatures exclusively focusing on AI-powered particle therapy. Six major aspects are included: treatment planning, dose calculation, range and dose verification, image guidance, quality assurance and adaptive replanning. A number of perspectives as well as potential challenges and common pitfalls, are also discussed.

We evaluated the temporal performance of a deep learning (DL) based artificial intelligence (AI) model for auto segmentation in prostate radiotherapy, seeking to correlate its efficacy with changes in clinical landscapes. Our study involved 1328 prostate cancer patients who underwent definitive radiotherapy from January 2006 to August 2022 at the University of Texas Southwestern Medical Center. We trained a UNet based segmentation model on data from 2006 to 2011 and tested it on data from 2012 to 2022 to simulate real world clinical deployment. We measured the model performance using the Dice similarity coefficient (DSC), visualized the trends in contour quality using exponentially weighted moving average (EMA) curves. Additionally, we performed Wilcoxon Rank Sum Test to analyze the differences in DSC distributions across distinct periods, and multiple linear regression to investigate the impact of various clinical factors. The model exhibited peak performance in the initial phase (from 2012 to 2014) for segmenting the prostate, rectum, and bladder. However, we observed a notable decline in performance for the prostate and rectum after 2015, while bladder contour quality remained stable. Key factors that impacted the prostate contour quality included physician contouring styles, the use of various hydrogel spacer, CT scan slice thickness, MRI-guided contouring, and using intravenous (IV) contrast. Rectum contour quality was influenced by factors such as slice thickness, physician contouring styles, and the use of various hydrogel spacers. The bladder contour quality was primarily affected by using IV contrast. This study highlights the challenges in maintaining AI model performance consistency in a dynamic clinical setting. It underscores the need for continuous monitoring and updating of AI models to ensure their ongoing effectiveness and relevance in patient care.

Prediction uncertainty estimation has clinical significance as it can potentially quantify prediction reliability. Clinicians may trust 'blackbox' models more if robust reliability information is available, which may lead to more models being adopted into clinical practice. There are several deep learning-inspired uncertainty estimation techniques, but few are implemented on medical datasets -- fewer on single institutional datasets/models. We sought to compare dropout variational inference (DO), test-time augmentation (TTA), conformal predictions, and single deterministic methods for estimating uncertainty using our model trained to predict feeding tube placement for 271 head and neck cancer patients treated with radiation. We compared the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) trends for each method at various cutoffs that sought to stratify patients into 'certain' and 'uncertain' cohorts. These cutoffs were obtained by calculating the percentile "uncertainty" within the validation cohort and applied to the testing cohort. Broadly, the AUC, sensitivity, and NPV increased as the predictions were more 'certain' -- i.e., lower uncertainty estimates. However, when a majority vote (implementing 2/3 criteria: DO, TTA, conformal predictions) or a stricter approach (3/3 criteria) were used, AUC, sensitivity, and NPV improved without a notable loss in specificity or PPV. Especially for smaller, single institutional datasets, it may be important to evaluate multiple estimations techniques before incorporating a model into clinical practice., Comment: 12 pages, 5 figures

Cone-beam CT (CBCT)-based online adaptive radiotherapy calls for accurate auto-segmentation to reduce the time cost for physicians to edit contours. However, deep learning (DL)-based direct segmentation of CBCT images is a challenging task, mainly due to the poor image quality and lack of well-labelled large training datasets. Deformable image registration (DIR) is often used to propagate the manual contours on the planning CT (pCT) of the same patient to CBCT. In this work, we undertake solving the problems mentioned above with the assistance of DIR. Our method consists of three main components. First, we use deformed pCT contours derived from multiple DIR methods between pCT and CBCT as pseudo labels for initial training of the DL-based direct segmentation model. Second, we use deformed pCT contours from another DIR algorithm as influencer volumes to define the region of interest for DL-based direct segmentation. Third, the initially trained DL model is further fine-tuned using a smaller set of true labels. We found that DL-based direct segmentation on CBCT trained with pseudo labels and without influencer volumes shows poor performance compared to DIR-based segmentation. However, adding deformed pCT contours as influencer volumes in the direct segmentation network dramatically improves segmentation performance, reaching the accuracy level of DIR-based segmentation. The DL model with influencer volumes can be further improved through fine-tuning using a smaller set of true labels. Experiments showed that 7 out of 19 structures have an at least 0.2 Dice similarity coefficient increase compared to DIR-based segmentation. A DL-based direct CBCT segmentation model can be improved to outperform DIR-based segmentation models by using deformed pCT contours as pseudo labels and influencer volumes for initial training, and by using a smaller set of true labels for model fine tuning.

Medical image registration is a fundamental and vital task which will affect the efficacy of many downstream clinical tasks. Deep learning (DL)-based deformable image registration (DIR) methods have been investigated, showing state-of-the-art performance. A test time optimization (TTO) technique was proposed to further improve the DL models' performance. Despite the substantial accuracy improvement with this TTO technique, there still remained some regions that exhibited large registration errors even after many TTO iterations. To mitigate this challenge, we firstly identified the reason why the TTO technique was slow, or even failed, to improve those regions' registration results. We then proposed a two-levels TTO technique, i.e., image-specific optimization (ISO) and region-specific optimization (RSO), where the region can be interactively indicated by the clinician during the registration result reviewing process. For both efficiency and accuracy, we further envisioned a three-step DL-based image registration workflow. Experimental results showed that our proposed method outperformed the conventional method qualitatively and quantitatively.

We establish an open framework for developing plan optimization models for knowledge-based planning (KBP) in radiotherapy. Our framework includes reference plans for 100 patients with head-and-neck cancer and high-quality dose predictions from 19 KBP models that were developed by different research groups during the OpenKBP Grand Challenge. The dose predictions were input to four optimization models to form 76 unique KBP pipelines that generated 7600 plans. The predictions and plans were compared to the reference plans via: dose score, which is the average mean absolute voxel-by-voxel difference in dose a model achieved; the deviation in dose-volume histogram (DVH) criterion; and the frequency of clinical planning criteria satisfaction. We also performed a theoretical investigation to justify our dose mimicking models. The range in rank order correlation of the dose score between predictions and their KBP pipelines was 0.50 to 0.62, which indicates that the quality of the predictions is generally positively correlated with the quality of the plans. Additionally, compared to the input predictions, the KBP-generated plans performed significantly better (P<0.05; one-sided Wilcoxon test) on 18 of 23 DVH criteria. Similarly, each optimization model generated plans that satisfied a higher percentage of criteria than the reference plans. Lastly, our theoretical investigation demonstrated that the dose mimicking models generated plans that are also optimal for a conventional planning model. This was the largest international effort to date for evaluating the combination of KBP prediction and optimization models. In the interest of reproducibility, our data and code is freely available at https://github.com/ababier/open-kbp-opt., Comment: 19 pages, 7 tables, 6 figures

Online adaptive radiotherapy (ART) requires accurate and efficient auto-segmentation of target volumes and organs-at-risk (OARs) in mostly cone-beam computed tomography (CBCT) images. Propagating expert-drawn contours from the pre-treatment planning CT (pCT) through traditional or deep learning (DL) based deformable image registration (DIR) can achieve improved results in many situations. Typical DL-based DIR models are population based, that is, trained with a dataset for a population of patients, so they may be affected by the generalizability problem. In this paper, we propose a method called test-time optimization (TTO) to refine a pre-trained DL-based DIR population model, first for each individual test patient, and then progressively for each fraction of online ART treatment. Our proposed method is less susceptible to the generalizability problem, and thus can improve overall performance of different DL-based DIR models by improving model accuracy, especially for outliers. Our experiments used data from 239 patients with head and neck squamous cell carcinoma to test the proposed method. Firstly, we trained a population model with 200 patients, and then applied TTO to the remaining 39 test patients by refining the trained population model to obtain 39 individualized models. We compared each of the individualized models with the population model in terms of segmentation accuracy. The number of patients with at least 0.05 DSC improvement or 2 mm HD95 improvement by TTO averaged over the 17 selected structures for the state-of-the-art architecture Voxelmorph is 10 out of 39 test patients. The average time for deriving the individualized model using TTO from the pre-trained population model is approximately four minutes. When adapting the individualized model to a later fraction of the same patient, the average time is reduced to about one minute and the accuracy is slightly improved.

Automatic segmentation of anatomical structures is critical for many medical applications. However, the results are not always clinically acceptable and require tedious manual revision. Here, we present a novel concept called artificial intelligence assisted contour revision (AIACR) and demonstrate its feasibility. The proposed clinical workflow of AIACR is as follows given an initial contour that requires a clinicians revision, the clinician indicates where a large revision is needed, and a trained deep learning (DL) model takes this input to update the contour. This process repeats until a clinically acceptable contour is achieved. The DL model is designed to minimize the clinicians input at each iteration and to minimize the number of iterations needed to reach acceptance. In this proof-of-concept study, we demonstrated the concept on 2D axial images of three head-and-neck cancer datasets, with the clinicians input at each iteration being one mouse click on the desired location of the contour segment. The performance of the model is quantified with Dice Similarity Coefficient (DSC) and 95th percentile of Hausdorff Distance (HD95). The average DSC/HD95 (mm) of the auto-generated initial contours were 0.82/4.3, 0.73/5.6 and 0.67/11.4 for three datasets, which were improved to 0.91/2.1, 0.86/2.4 and 0.86/4.7 with three mouse clicks, respectively. Each DL-based contour update requires around 20 ms. We proposed a novel AIACR concept that uses DL models to assist clinicians in revising contours in an efficient and effective way, and we demonstrated its feasibility by using 2D axial CT images from three head-and-neck cancer datasets.

Typically, the current dose prediction models are limited to small amounts of data and require re-training for a specific site, often leading to suboptimal performance. We propose a site-agnostic, 3D dose distribution prediction model using deep learning that can leverage data from any treatment site, thus increasing the total data available to train the model. Applying our proposed model to a new target treatment site requires only a brief fine-tuning of the model to the new data and involves no modifications to the model input channels or its parameters. Thus, it can be efficiently adapted to a different treatment site, even with a small training dataset.

Volumetric modulated arc therapy planning is a challenging problem in high-dimensional, non-convex optimization. Traditionally, heuristics such as fluence-map-optimization-informed segment initialization use locally optimal solutions to begin the search of the full arc therapy plan space from a reasonable starting point. These routines facilitate arc therapy optimization such that clinically satisfactory radiation treatment plans can be created in about 10 minutes. However, current optimization algorithms favor solutions near their initialization point and are slower than necessary due to plan overparameterization. In this work, arc therapy overparameterization is addressed by reducing the effective dimension of treatment plans with unsupervised deep learning. An optimization engine is then built based on low-dimensional arc representations which facilitates faster planning times.