arXiv subjects

Steve Jiang

Publications and source records attributed to Steve Jiang.

At least 55 records · Page 3Linked to original sources

arXiv2020

Dose Prediction with Deep Learning for Prostate Cancer Radiation Therapy: Model Adaptation to Different Treatment Planning Practices

This work aims to study the generalizability of a pre-developed deep learning (DL) dose prediction model for volumetric modulated arc therapy (VMAT) for prostate cancer and to adapt the model to three different internal treatment planning styles and one external institution planning style. We built the source model with planning data from 108 patients previously treated with VMAT for prostate cancer. For the transfer learning, we selected patient cases planned with three different styles from the same institution and one style from a different institution to adapt the source model to four target models. We compared the dose distributions predicted by the source model and the target models with the clinical dose predictions and quantified the improvement in the prediction quality for the target models over the source model using the Dice similarity coefficients (DSC) of 10% to 100% isodose volumes and the dose-volume-histogram (DVH) parameters of the planning target volume and the organs-at-risk. The source model accurately predicts dose distributions for plans generated in the same source style but performs sub-optimally for the three internal and one external target styles, with the mean DSC ranging between 0.81-0.94 and 0.82-0.91 for the internal and the external styles, respectively. With transfer learning, the target model predictions improved the mean DSC to 0.88-0.95 and 0.92-0.96 for the internal and the external styles, respectively. Target model predictions significantly improved the accuracy of the DVH parameter predictions to within 1.6%. We demonstrated model generalizability for DL-based dose prediction and the feasibility of using transfer learning to solve this problem. With 14-29 cases per style, we successfully adapted the source model into several different practice styles. This indicates a realistic way to widespread clinical implementation of DL-based dose prediction.

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arXiv2020

Using Deep Learning to Predict Beam-Tunable Pareto Optimal Dose Distribution for Intensity Modulated Radiation Therapy

We propose to develop deep learning models that can predict Pareto optimal dose distributions by using any given set of beam angles, along with patient anatomy, as input to train the deep neural networks. We implement and compare two deep learning networks that predict with two different beam configuration modalities. We generated Pareto optimal plans for 70 patients with prostate cancer. We used fluence map optimization to generate 500 IMRT plans that sampled the Pareto surface for each patient, for a total of 35,000 plans. We studied and compared two different models, Model I and Model II. Model I directly uses beam angles as a second input to the network as a binary vector. Model II converts the beam angles into beam doses that are conformal to the PTV. Our deep learning models predicted voxel-level dose distributions that precisely matched the ground truth dose distributions. Quantitatively, Model I prediction error of 0.043 (confirmation), 0.043 (homogeneity), 0.327 (R50), 2.80% (D95), 3.90% (D98), 0.6% (D50), 1.10% (D2) was lower than that of Model II, which obtained 0.076 (confirmation), 0.058 (homogeneity), 0.626 (R50), 7.10% (D95), 6.50% (D98), 8.40% (D50), 6.30% (D2). Treatment planners who use our models will be able to use deep learning to control the tradeoffs between the PTV and OAR weights, as well as the beam number and configurations in real time. Our dose prediction methods provide a stepping stone to building automatic IMRT treatment planning.

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arXiv2020

Boosting radiotherapy dose calculation accuracy with deep learning

In radiotherapy, a trade-off exists between computational workload/speed and dose calculation accuracy. Calculation methods like pencil-beam convolution can be much faster than Monte-Carlo methods, but less accurate. The dose difference, mostly caused by inhomogeneities and electronic disequilibrium, is highly correlated with the dose distribution and the underlying anatomical tissue density. We hypothesize that a conversion scheme can be established to boost low-accuracy doses to high-accuracy, using intensity information obtained from computed tomography (CT) images. A deep learning-driven framework was developed to test the hypothesis by converting between two commercially-available dose calculation methods: AAA (anisotropic-analytic-algorithm) and AXB (Acuros XB).A hierarchically-dense U-Net model was developed to boost the accuracy of AAA dose towards the AXB level. The network contained multiple layers of varying feature sizes to learn their dose differences, in relationship to CT, both locally and globally. AAA and AXB doses were calculated in pairs for 120 lung radiotherapy plans covering various treatment techniques, beam energies, tumor locations, and dose levels.

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arXiv2020

Mining Domain Knowledge: Improved Framework towards Automatically Standardizing Anatomical Structure Nomenclature in Radiotherapy

The automatic standardization of nomenclature for anatomical structures in radiotherapy (RT) clinical data is a critical prerequisite for data curation and data-driven research in the era of big data and artificial intelligence, but it is currently an unmet need. Existing methods either cannot handle cross-institutional datasets or suffer from heavy imbalance and poor-quality delineation in clinical RT datasets. To solve these problems, we propose an automated structure nomenclature standardization framework, 3D Non-local Network with Voting (3DNNV). This framework consists of an improved data processing strategy, namely, adaptive sampling and adaptive cropping (ASAC) with voting, and an optimized feature extraction module. The framework simulates clinicians' domain knowledge and recognition mechanisms to identify small-volume organs at risk (OARs) with heavily imbalanced data better than other methods. We used partial data from an open-source head-and-neck cancer dataset to train the model, then tested the model on three cross-institutional datasets to demonstrate its generalizability. 3DNNV outperformed the baseline model, achieving higher average true positive rates (TPR) overall categories on the three test datasets (+8.27%, +2.39%, and +5.53%, respectively). More importantly, the 3DNNV outperformed the baseline on the test dataset, 28.63% to 91.17%, in terms of F1 score for a small-volume OAR with only 9 training samples. The results show that 3DNNV can be applied to identify OARs, even error-prone ones. Furthermore, we discussed the limitations and applicability of the framework in practical scenarios. The framework we developed can assist in standardizing structure nomenclature to facilitate data-driven clinical research in cancer radiotherapy.

cs.CV↗

arXiv2020

A deep learning-based framework for segmenting invisible clinical target volumes with estimated uncertainties for post-operative prostate cancer radiotherapy

In post-operative radiotherapy for prostate cancer, the cancerous prostate gland has been surgically removed, so the clinical target volume (CTV) to be irradiated encompasses the microscopic spread of tumor cells, which cannot be visualized in typical clinical images such as computed tomography or magnetic resonance imaging. In current clinical practice, physicians segment CTVs manually based on their relationship with nearby organs and other clinical information, per clinical guidelines. Automating post-operative prostate CTV segmentation with traditional image segmentation methods has been a major challenge. Here, we propose a deep learning model to overcome this problem by segmenting nearby organs first, then using their relationship with the CTV to assist CTV segmentation. The model proposed is trained using labels clinically approved and used for patient treatment, which are subject to relatively large inter-physician variations due to the absence of a visual ground truth. The model achieves an average Dice similarity coefficient (DSC) of 0.87 on a holdout dataset of 50 patients, much better than established methods, such as atlas-based methods (DSC<0.7). The uncertainties associated with automatically segmented CTV contours are also estimated to help physicians inspect and revise the contours, especially in areas with large inter-physician variations. We also use a 4-point grading system to show that the clinical quality of the automatically segmented CTV contours is equal to that of approved clinical contours manually drawn by physicians.

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arXiv2020

Generalizability issues with deep learning models in medicine and their potential solutions: illustrated with Cone-Beam Computed Tomography (CBCT) to Computed Tomography (CT) image conversion

Generalizability is a concern when applying a deep learning (DL) model trained on one dataset to other datasets. Training a universal model that works anywhere, anytime, for anybody is unrealistic. In this work, we demonstrate the generalizability problem, then explore potential solutions based on transfer learning (TL) by using the cone-beam computed tomography (CBCT) to computed tomography (CT) image conversion task as the testbed. Previous works have converted CBCT to CT-like images. However, all of those works studied only one or two anatomical sites and used images from the same vendor's scanners. Here, we investigated how a model trained for one machine and one anatomical site works on other machines and other sites. We trained a model on CBCT images acquired from one vendor's scanners for head and neck cancer patients and applied it to images from another vendor's scanners and for other disease sites. We found that generalizability could be a significant problem for this particular application when applying a trained DL model to datasets from another vendor's scanners. We then explored three practical solutions based on TL to solve this generalization problem: the target model, which is trained on a target domain from scratch; the combined model, which is trained on both source and target domain datasets from scratch; and the adapted model, which fine-tunes the trained source model to a target domain. We found that when there are sufficient data in the target domain, all three models can achieve good performance. When the target dataset is limited, the adapted model works the best, which indicates that using the fine-tuning strategy to adapt the trained model to an unseen target domain dataset is a viable and easy way to implement DL models in the clinic.

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arXiv2020

A reinforcement learning application of guided Monte Carlo Tree Search algorithm for beam orientation selection in radiation therapy

Due to the large combinatorial problem, current beam orientation optimization algorithms for radiotherapy, such as column generation (CG), are typically heuristic or greedy in nature, leading to suboptimal solutions. We propose a reinforcement learning strategy using Monte Carlo Tree Search capable of finding a superior beam orientation set and in less time than CG.We utilized a reinforcement learning structure involving a supervised learning network to guide Monte Carlo tree search (GTS) to explore the decision space of beam orientation selection problem. We have previously trained a deep neural network (DNN) that takes in the patient anatomy, organ weights, and current beams, and then approximates beam fitness values, indicating the next best beam to add. This DNN is used to probabilistically guide the traversal of the branches of the Monte Carlo decision tree to add a new beam to the plan. To test the feasibility of the algorithm, we solved for 5-beam plans, using 13 test prostate cancer patients, different from the 57 training and validation patients originally trained the DNN. To show the strength of GTS to other search methods, performances of three other search methods including a guided search, uniform tree search and random search algorithms are also provided. On average GTS outperforms all other methods, it find a solution better than CG in 237 seconds on average, compared to CG which takes 360 seconds, and outperforms all other methods in finding a solution with lower objective function value in less than 1000 seconds. Using our guided tree search (GTS) method we were able to maintain a similar planning target volume (PTV) coverage within 1% error, and reduce the organ at risk (OAR) mean dose for body, rectum, left and right femoral heads, but a slight increase of 1% in bladder mean dose.

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arXiv2020

Improving Proton Dose Calculation Accuracy by Using Deep Learning

Accurate dose calculation is vitally important for proton therapy. Pencil beam (PB) model-based dose calculation is fast but inaccurate due to the approximation when dealing with inhomogeneities. Monte Carlo (MC) dose calculation is the most accurate method, but it is time consuming. We hypothesize that deep learning methods can boost the accuracy of PB dose calculation to the level of MC. In this work, we developed a deep learning model that converts PB to MC doses for different tumor sites. The proposed model is based on our newly developed hierarchically densely connected U-Net (HD U-Net) network, and it uses the PB dose and patient CT image as inputs to generate the MC dose. We used 290 patients (90 with head and neck, 93 with liver, 75 with prostate, and 32 with lung cancer) to train, validate, and test the model. For each tumor site, we performed four numerical experiments to explore various combinations of training datasets. Training the model on data from all tumor sites together and using the dose distribution of each individual beam as input yielded the best performance for all four tumor sites. The average gamma index (1mm/1% criteria) between the converted dose and the MC dose was 92.8%, 92.7%, 89.7% and 99.6% for head and neck, liver, lung, and prostate test patients, respectively. The average time for dose conversion for a single field was less than 4 seconds. In conclusion, our deep learning-based approach can quickly boost the accuracy of proton PB dose distributions to that of MC dose distributions. The trained model can be readily adapted to new datasets for different tumor sites and from different hospitals through transfer learning. This model can be added as a plug-in to the clinical workflow of proton therapy treatment planning to improve the accuracy of proton dose calculation.

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arXiv2020

Development of a Real-time Indoor Location System using Bluetooth Low Energy Technology and Deep Learning to Facilitate Clinical Applications

An indoor, real-time location system (RTLS) can benefit both hospitals and patients by improving clinical efficiency through data-driven optimization of procedures. Bluetooth-based RTLS systems are cost-effective but lack accuracy and robustness because Bluetooth signal strength is subject to fluctuation. We developed a machine learning-based solution using a Long Short-Term Memory (LSTM) network followed by a Multilayer Perceptron classifier and a posterior constraint algorithm to improve RTLS performance. Training and validation datasets showed that most machine learning models perform well in classifying individual location zones, although LSTM was most reliable. However, when faced with data indicating cross-zone trajectories, all models showed erratic zone switching. Thus, we implemented a history-based posterior constraint algorithm to reduce the variability in exchange for a slight decrease in responsiveness. This network increases robustness at the expense of latency. When latency is less of a concern, we computed the latency-corrected accuracy which is 100% for our testing data, significantly improved from LSTM without constraint which is 96.2%. The balance between robustness and responsiveness can be considered and adjusted on a case-by-case basis, according to the specific needs of downstream clinical applications. This system was deployed and validated in an academic medical center. Industry best practices enabled system scaling without substantial compromises to performance or cost.

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arXiv2019

A Fast Deep Learning Approach for Beam Orientation Optimization for Prostate Cancer IMRT Treatments

We propose a fast beam orientation selection method, based on deep neural networks (DNN), capable of developing a plan comparable to those by the state-of-the-art column generation method. The novelty of Our model lies in its supervised learning structure, the DNN architecture, and ability to learn from anatomical features to predict dosimetrically suitable beam orientations without using the dosimetric information from the candidate beams, a time consuming and computationally expensive process. This may save hours of computation. A supervised DNN is trained to mimic the column generation algorithm, which iteratively chooses beam orientations by calculating beam fitness values based on the KKT optimality conditions. The dataset contains 70 prostate cancer patients. The DNN trained over 400 epochs, each with 2500 steps, using the Adam optimizer and a 6-fold cross-validation technique. The average and standard deviation of training, validation, and testing loss functions among the 6-folds were at most 1.44%. The differences in the dose coverage of PTV between plans generated by column generation and by DNN were 0.2%. The average dose differences received by organs at risk were between 1 and 6 percent: bladder had the smallest average difference, then rectum, left and right femoral heads. The dose received by body had an average difference of 0.1%. In the training phase of the proposed method, the model learns the suitable beam orientations based on the anatomical features of patients and omits time intensive calculations of dose influence matrices for all possible candidate beams. Solving the Fluence Map Optimization to get the final treatment plan requires calculating dose influence matrices only for the selected beams. The proposed DNN is a fast beam orientation selection method based that selects beam orientations in seconds and is therefore suitable for clinical routines.

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arXiv2019

Incorporating human and learned domain knowledge into training deep neural networks: A differentiable dose volume histogram and adversarial inspired framework for generating Pareto optimal dose distributions in radiation therapy

We propose a novel domain specific loss, which is a differentiable loss function based on the dose volume histogram, and combine it with an adversarial loss for the training of deep neural networks to generate Pareto optimal dose distributions. The mean squared error (MSE) loss, dose volume histogram (DVH) loss, and adversarial (ADV) loss were used to train 4 instances of the neural network model: 1) MSE, 2) MSE+ADV, 3) MSE+DVH, and 4) MSE+DVH+ADV. 70 prostate patients were acquired, and the dose influence arrays were calculated for each patient. 1200 Pareto surface plans per patient were generated by pseudo-randomizing the tradeoff weights (84,000 plans total). We divided the data into 54 training, 6 validation, and 10 testing patients. Each model was trained for 100,000 iterations, with a batch size of 2. The prediction time of each model is 0.052 seconds. Quantitatively, the MSE+DVH+ADV model had the lowest prediction error of 0.038 (conformation), 0.026 (homogeneity), 0.298 (R50), 1.65% (D95), 2.14% (D98), 2.43% (D99). The MSE model had the worst prediction error of 0.134 (conformation), 0.041 (homogeneity), 0.520 (R50), 3.91% (D95), 4.33% (D98), 4.60% (D99). For both the mean dose PTV error and the max dose PTV, Body, Bladder and rectum error, the MSE+DVH+ADV outperformed all other models. All model's predictions have an average mean and max dose error less than 2.8% and 4.2%, respectively. Expert human domain specific knowledge can be the largest driver in the performance improvement, and adversarial learning can be used to further capture nuanced features. The real-time prediction capabilities allow for a physician to quickly navigate the tradeoff space, and produce a dose distribution as a tangible endpoint for the dosimetrist to use for planning. This can considerably reduce the treatment planning time, allowing for clinicians to focus their efforts on challenging cases.

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arXiv2019

A Feasibility Study on Deep Learning-Based Radiotherapy Dose Calculation

Purpose: Various dose calculation algorithms are available for radiation therapy for cancer patients. However, these algorithms are faced with the tradeoff between efficiency and accuracy. The fast algorithms are generally less accurate, while the accurate dose engines are often time consuming. In this work, we try to resolve this dilemma by exploring deep learning (DL) for dose calculation. Methods: We developed a new radiotherapy dose calculation engine based on a modified Hierarchically Densely Connected U-net (HD U-net) model and tested its feasibility with prostate intensity-modulated radiation therapy (IMRT) cases. Mapping from an IMRT fluence map domain to a 3D dose domain requires a deep neural network of complicated architecture and a huge training dataset. To solve this problem, we first project the fluence maps to the dose domain using a modified ray-tracing algorithm, and then we use the HD U-net to map the ray-tracing dose distribution into an accurate dose distribution calculated using a collapsed cone convolution/superposition (CS) algorithm. Results: It takes about one second to compute a 3D dose distribution for a typical 7-field prostate IMRT plan, which can be further reduced to achieve real-time dose calculation by optimizing the network. For all eight testing patients, evaluation with Gamma Index and various clinical goals for IMRT optimization shows that the DL dose distributions are clinically identical to the CS dose distributions. Conclusions: We have shown the feasibility of using DL for calculating radiotherapy dose distribution with high accuracy and efficiency.

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arXiv2019

Generating Pareto optimal dose distributions for radiation therapy treatment planning

Radiotherapy treatment planning currently requires many trail-and-error iterations between the planner and treatment planning system, as well as between the planner and physician for discussion/consultation. The physician's preferences for a particular patient cannot be easily quantified and precisely conveyed to the planner. In this study we present a real-time volumetric Pareto surface dose generation deep learning neural network that can be used after segmentation by the physician, adding a tangible and quantifiable end-point to portray to the planner. From 70 prostate patients, we first generated 84,000 intensity modulated radiation therapy plans (1,200 plans per patient) sampling the Pareto surface, representing various tradeoffs between the planning target volume (PTV) and the organs-at-risk (OAR), including bladder, rectum, left femur, right femur, and body. We divided the data to 10 test patients and 60 training/validation patients. We then trained a hierarchically densely connected convolutional U-net (HD U-net), to take the PTV and avoidance map representing OARs masks and weights, and predict the optimized plan. The HD U-net is capable of accurately predicting the 3D Pareto optimal dose distributions, with average [mean, max] dose errors of [3.4%, 7.7%](PTV), [1.6%, 5.6%](bladder), [3.7%, 4.2%](rectum), [3.2%, 8.0%](left femur), [2.9%, 7.7%](right femur), and [0.04%, 5.4%](body) of the prescription dose. The PTV dose coverage prediction was also very similar, with errors of 1.3% (D98) and 2.0% (D99). Homogeneity was also similar, differing by 0.06 on average. The neural network can predict the dose within 1.7 seconds. Clinically, the optimization and dose calculation is much slower, taking 5-10 minutes.

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arXiv2019

Three-Dimensional Dose Prediction for Lung IMRT Patients with Deep Neural Networks: Robust Learning from Heterogeneous Beam Configurations

The use of neural networks to directly predict three-dimensional dose distributions for automatic planning is becoming popular. However, the existing methods only use patient anatomy as input and assume consistent beam configuration for all patients in the training database. The purpose of this work is to develop a more general model that, in addition to patient anatomy, also considers variable beam configurations, to achieve a more comprehensive automatic planning with a potentially easier clinical implementation, without the need of training specific models for different beam settings.

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arXiv2019

MRI-only brain radiotherapy: assessing the dosimetric accuracy of synthetic CT images generated using a deep learning approach

Purpose: This study assessed the dosimetric accuracy of synthetic CT images generated from magnetic resonance imaging (MRI) data for focal brain radiation therapy, using a deep learning approach. Material and Methods: We conducted a study in 77 patients with brain tumors who had undergone both MRI and computed tomography (CT) imaging as part of their simulation for external beam treatment planning. We designed a generative adversarial network (GAN) to generate synthetic CT images from MRI images. We used Mutual Information (MI) as the loss function in the generator to overcome the misalignment between MRI and CT images (unregistered data). The model was trained using all MRI slices with corresponding CT slices from each training subject s MRI/CT pair. Results: The proposed GAN method produced an average mean absolute error (MAE) of 47.2 +- 11.0 HU over 5-fold cross validation. The overall mean Dice similarity coefficient between CT and synthetic CT images was 80% +- 6% in bone for all test data. Though training a GAN model may take several hours, the model only needs to be trained once. Generating a complete synthetic CT volume for each new patient MRI volume using a trained GAN model took only one second. Conclusions: The GAN model we developed produced highly accurate synthetic CT images from conventional, single-sequence MRI images in seconds. Our proposed method has strong potential to perform well in a clinical workflow for MRI-only brain treatment planning.

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arXiv2019

Automatic multi-objective based feature selection for classification

Objective: Accurately classifying the malignancy of lesions detected in a screening scan is critical for reducing false positives. Radiomics holds great potential to differentiate malignant from benign tumors by extracting and analyzing a large number of quantitative image features. Since not all radiomic features contribute to an effective classifying model, selecting an optimal feature subset is critical. Methods: This work proposes a new multi-objective based feature selection (MO-FS) algorithm that considers sensitivity and specificity simultaneously as the objective functions during feature selection. For MO-FS, we developed a modified entropy based termination criterion (METC) that stops the algorithm automatically rather than relying on a preset number of generations. We also designed a solution selection methodology for multi-objective learning that uses the evidential reasoning approach (SMOLER) to automatically select the optimal solution from the Pareto-optimal set. Furthermore, we developed an adaptive mutation operation to generate the mutation probability in MO-FS automatically. Results: We evaluated the MO-FS for classifying lung nodule malignancy in low-dose CT and breast lesion malignancy in digital breast tomosynthesis. Conclusion: The experimental results demonstrated that the feature set selected by MO-FS achieved better classification performance than features selected by other commonly used methods. Significance: The proposed method is general and more effective radiomic feature selection strategy.

cs.CV↗

arXiv2019

Three-Dimensional Radiotherapy Dose Prediction on Head and Neck Cancer Patients with a Hierarchically Densely Connected U-net Deep Learning Architecture

The treatment planning process for patients with head and neck (H&N) cancer is regarded as one of the most complicated due to large target volume, multiple prescription dose levels, and many radiation-sensitive critical structures near the target. Treatment planning for this site requires a high level of human expertise and a tremendous amount of effort to produce personalized high quality plans, taking as long as a week, which deteriorates the chances of tumor control and patient survival. To solve this problem, we propose to investigate a deep learning-based dose prediction model, Hierarchically Densely Connected U-net, based on two highly popular network architectures: U-net and DenseNet. We find that this new architecture is able to accurately and efficiently predict the dose distribution, outperforming the other two models, the Standard U-net and DenseNet, in homogeneity, dose conformity, and dose coverage on the test data. Averaging across all organs at risk, our proposed model is capable of predicting the organ-at-risk max dose within 6.3% and mean dose within 5.1% of the prescription dose on the test data. The other models, the Standard U-net and DenseNet, performed worse, having an averaged organ-at-risk max dose prediction error of 8.2% and 9.3%, respectively, and averaged mean dose prediction error of 6.4% and 6.8%, respectively. In addition, our proposed model used 12 times less trainable parameters than the Standard U-net, and predicted the patient dose 4 times faster than DenseNet.

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arXiv2018

Predicting Lung Nodule Malignancies by Combining Deep Convolutional Neural Network and Handcrafted Features

To predict lung nodule malignancy with a high sensitivity and specificity, we propose a fusion algorithm that combines handcrafted features (HF) into the features learned at the output layer of a 3D deep convolutional neural network (CNN). First, we extracted twenty-nine handcrafted features, including nine intensity features, eight geometric features, and twelve texture features based on grey-level co-occurrence matrix (GLCM) averaged from thirteen directions. We then trained 3D CNNs modified from three state-of-the-art 2D CNN architectures (AlexNet, VGG-16 Net and Multi-crop Net) to extract the CNN features learned at the output layer. For each 3D CNN, the CNN features combined with the 29 handcrafted features were used as the input for the support vector machine (SVM) coupled with the sequential forward feature selection (SFS) method to select the optimal feature subset and construct the classifiers. The fusion algorithm takes full advantage of the handcrafted features and the highest level CNN features learned at the output layer. It can overcome the disadvantage of the handcrafted features that may not fully reflect the unique characteristics of a particular lesion by combining the intrinsic CNN features. Meanwhile, it also alleviates the requirement of a large scale annotated dataset for the CNNs based on the complementary of handcrafted features. The patient cohort includes 431 malignant nodules and 795 benign nodules extracted from the LIDC/IDRI database. For each investigated CNN architecture, the proposed fusion algorithm achieved the highest AUC, accuracy, sensitivity, and specificity scores among all competitive classification models.

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