“Under the hood”: artificial intelligence in personalized radiotherapy

This review presents and discusses the ways in which artificial intelligence (AI) tools currently intervene, or could potentially intervene in the future, to enhance the diverse tasks involved in the radiotherapy workflow. The radiotherapy framework is presented on two different levels for the personalization of the treatment, distinct in tasks and methodologies. The first level is the clinically well-established anatomy-based workflow, known as adaptive radiation therapy (ART). The second level is referred to as biology-driven workflow, explored in research literature and recently appearing in some preliminary clinical trials for personalized radiation treatments. A twofold role for AI is defined according to these two different levels. In the anatomy-based workflow, the role of AI is to streamline and improve the tasks in terms of time and variability reductions compared to conventional methodologies. The biology-driven workflow instead fully relies on AI, which introduces decision-making tools opening uncharted frontiers which were in the past deemed challenging to explore. These methodologies are referred to as radiomics and dosiomics, handling imaging and dosimetric information, or to multiomics, when complemented by clinical and biological parameters (i.e., biomarkers). The review explicitly highlights the methodologies that are currently incorporated into clinical practice or still in research, with the aim of presenting the AI’s growing role in personalized radiotherapy.