A novel data-driven algorithm to predict anomalous prescription based on patient's feature set

Abstract

Appropriate dosing of radiation is crucial to patient safety in radiotherapy. Current quality assurance depends heavily on a peer-review process, where the physician's peer review on each patient's treatment plan including dose and fractionation. However, such a process is manual and laborious. Physicians may not identify errors due to time constraints and case load. We designed a novel prescription anomaly detection algorithm that utilizes historical data from the past to predict anomalous cases. Such a tool can serve as an electronic peer who will assist the peer-review process providing extra safety to the patients. In our primary model, we created two dissimilarity metrics, R and F . R defining how far a new patient's prescription is from historical prescriptions. F represents how far away a patient's feature set is from that of the group with an identical or similar prescription. We flag prescription if either metric is greater than specific optimized cut-off values.We used thoracic cancer patients (n = 2356) as an example and extracted seven features. Here, we report our testing f1 score, which is between 73%-94% for different treatment technique groups.We also independently validate our results by conducting a mock peer review with three thoracic specialists. Our model has a lower type II error rate compared to manual peer-review physicians.Our model has many advantages over traditional machine learning algorithms, particularly that it does not suffer from class-imbalance. It can also explain why it flags each case and separate prescription and non-prescription-related features without learning from the data.