Individually-tailored Clinical Decision Support for Management of Indeterminate Pulmonary Nodules (R01 CA226079; PI: Bui, Aberle)
The rollout of low-dose computed tomography (LDCT) lung screening programs is accelerating in the United States, aiming for earlier detection of lung cancer to improve long-term survival. However, a consequence of such imaging programs is the increased discovery of indeterminate pulmonary nodules (IPNs). Significant questions remain around the effective management of screen- and incidentally-detected IPNs: while many are benign, a fraction will go on to become cancerous.
The objective of this R01 is the development of a clinical decision support tool for the management of screen- and incidentally-detected IPNs. We address two key challenges: 1) the development of a continuous-time model for predicting how the IPN will evolve; and 2) the use of this prediction to determine a series of actions over time that will optimize (screening) outcomes for the individual. We first explore the development of a continuous time belief network (CTBN), a temporal probabilistic model to predict the likelihood of a patient to develop lung cancer. The probabilities computed through the CTBN are subsequently input into a partially-observable Markov decision process (POMDP) to guide IPN management decisions.