Preventive and precision medicine through big data in radiology
Abstract
       
This paper examines radiation information technology integrated with big data analytics and building solutions from the clinical trials with business analytics solutions from a list of patients.  This paper offers a cautionary tale on the quantum physics, hardware technology, and software technology of the radiation therapy and evaluates the ethical, social, and political issues created by high dose radiation therapy and extraction of data for performing bid data business analytics to cure cancer.  This paper examines the quantum physics of the ionized radiation and hardware equipment technology of the radiation therapy with the aid of Linear accelerators, multi-leaf collimators, and software technology used for beam-shaping technique generating the photons in the form of Gamma rays.  This paper discusses the side effects and damage that can arise from the overexposure of radiation that can permanently damage the DNA of the cell that’s in good condition thus heightening the ethical, social, and political issues from radiation treatments of cancer. 
 
Keywords: big data analytics, business intelligence analytics, hardware, software, ionized
                   radiation, radiation therapy
 
   
Introduction
 
Lauden, & Lauden (2011) discuss about the ethical, social, and political issues that are introduced by new revolutionary technologies on big data analytics and information systems platform for curing cancer.  Some of the revolutionary technologies have amplified the ethical concerns increasing the liability of the hospitals and questioning the responsibility and accountability of the top management of the hospitals introducing radiation therapy bolstered by the new big data technologies.  Red-hot Information systems have embraced leading-edge technologies, but question remains if these technologies continue the trend to pose ethical concerns (Laudon & Laudon, 2011).  Health Insurance Portability and Accountability Act (HIPAA) has laid out rules for transferring the data in radiology from one patient to another patient complying the fair information practice principles (FIPPs) for big data analytics (Easley, 2014).
 
   
Analysis
 
   
The radiation therapy began in the 1800s.  100+ types of cancer diseases can kill the humans rapidly.  The cell division multiplies significantly in cancer patients, compared to the regular cell division that occurs in the normal cells for healthy humans.  Radiation therapy technology has been making some controversial ethical and social issues in the applied medicine field with high dosages to cause DNA-damaging of the cancer cells.  Once the core of DNA of a cell destroyed by therapy, the tumor cell terminates in no time.  The challenge in the applied medicine field is to enable technological equipment that doesn’t damage the cells that are perfectly in good condition.  Big data analytics provides the vision for accurately predicting the provision of right dosage for radiation therapy.  There is a contrast between the radiation therapy and the chemotherapy.  The chemotherapy batters the cells as a therapy impacting the whole system while the radiation therapy works with ionized radiation as a localized treatment concentrating specific areas of cancer cells.  In the end, most of these radiation treatments work, and people will recover and move forward with their lives.  However, in cases where either there’s a human error, intuition or malfunctioning of the hardware technology that gives scope to ethical issues and can heighten the ethical, and political issues with the technologies such as linear accelerators, beam-shaping technique, multi-leaf collimators, ionized radiation.  To avoid the human error in radiology analysis, the introduction of big data analytics can significantly prevent the mistakes with counterintuitive insights and wring the value from the deluge of data coming from radiation therapy.  The healthcare practitioner has to work with big data architects, data scientists, and business analytics professionals to come up with the definition of metadata required for analysis and define the success metrics for the organization.  Establishment of business requirements gathering and requirements analysis determines the strategic value by extracting astounding amounts of medical imaging, cancer cells, X-rays, and alpha rays.  The organizational leadership has to define the goals for the data scientists for extracting a treasure-trove of data from external-beam radiation therapy, internal radiation therapy, and systematic radiation therapy complying HIPAA.  Various radiation therapy methods discussed below define the areas for performing big data analytics from which the data can be extracted (Howell, 2015). 
 
   
The radiation therapy targets several localized types of cancer cells destroying the DNA of the cancer cells.  The radiation therapy works by transforming the atoms or molecules into an ion.  The ion is a particular accelerated subatomic particle unlike the standard element from the periodic table, where the total number of electrons is not equal to the total number of protons in the atom.  The ionization is a controlled effect where the net impact of the particle can result in a total positive charge of the atom or total negative charge of the molecule by scrambling the number of electrons and protons.  If the atom were to gain the negative charge, it’s called anion and if the atom were to acquire positive charge it’s called cation.  The ionizing radiation applies into several fields such as nuclear fusion, fission, medicine and has been creating many applications in the daily life by generating X-rays, alpha rays, gamma and beta rays (Ronca, 2012). 
    
   
Though the X-rays, alpha rays and beta rays are implemented in several applied sciences including nuclear radiation, the gamma rays are mostly ionized for radiation therapy.  The alpha rays and beta rays are non-penetrating and hence can destroy the cells of the whole body.  Gamma rays with electromagnetic radiation have been selected for radiation therapy due to the deep penetration of these rays into the targeted localized areas of the body; sometimes X-rays are used for the radiation treatment as well depending on the cancer cells disintegration and division of multiple cells.  The dose limits of the gamma rays with controlled technology can cause side effects or can even kill the patient if not handled correctly (Ronca, 2012). 
    
External-beam radiation therapy
 
   
In this technique, the beams come through in the units of photons depending on the situation of the damage assessed from cancer with gamma rays.  Dependent on the level of deep penetration to the cell that can permanently damage the DNA in the core of the cell the beams are shaped and penetrated to the targeted and localized area.  One of the most popular methods is with the 3D CRT external radiation beam technique.  The hardware for 3D CRT external radiation beam technique is delivered by popular TomoDirect ® platform for brain cancer and lung cancer, etc.; the beam shaping technique with the 3D TomoDirect ® software package can allow to target precisely the areas with 20 gray dose limit for lung, 25 gray limit for the heart of the radiation therapy (Ferachi, 2003). 
 
But still the blend of the hardware and software of TomoDirect ® platform heightens the ethical and social issues for normal tissue exposure, as human error or software or hardware error can expose the patient to abnormal levels of radiation limits.  TomoDirect ® is the one of its kind hardware and software package that can run on the CT scan platform (Tofani, 2012).  The other type of radiation therapy is IMRT – Intensity-modulated radiation therapy.  In this therapy, there are multiple radiation beam-shaping technique devices that are used to launch a payload of radiation with multi-leaf collimators.  Radioactive source through the cathode or anode of the ionization chamber filters generate the beams.  The software of the IMRT fills with the necessary parameters then it calculates based on the 3D diagram of the tumor cell the number of beams that generate and the margins of the tissue.  The beam-shaping technique that can be used to perfect angled technique to annihilate the tumor cells in the localized target area (National Cancer Institute, 2010). 
 
 
Siemens 160 multileaf collimator is world’s renowned collimator that performs radiation therapy with ultra-blazing speeds to launch the payload of the radiation dose to the angled fixated particular targeted area.  The hundreds of metal leafs have a smooth transition for a pass through.  Each leaf travels at 4 centimeters/second for lightning speed radiation therapy for generating the required beam-shaping technique.  Siemens has developed special software ARTISTE plus, 160 multileaf collimators plus for Direct Aperture Optimization and Direct Machine Parameter Optimization.  With 160 multileaf collimators, the entire radiation therapy session can be completed under five minutes.  The ultimate combination of ultra-blazing speed and 0.01 degree accuracy results into maximizing the therapy on the localized targeted area for maximum impact.  The hardware technology of Siemens 160 multi-leaf collimator contains 80 leaves on both sides, the density of the crust of the leave does not exceed 5 mm in the radius field, and this level of calibration delivers ultimate flexibility and accuracy for the treatment.  This degree of precision ensures the normal tissue sparing.  The collimator offers a unique enclosure analysis with a highest spheroid section module of 40 centimeters at the isolated center of the multi-leaf collimator, this significantly reduces the risk exposure to the body while performing whole-body beaming (Siemens, 2009). 
 
 
The precision is vital to the radiation therapy as the accuracy of the metal leaf can create a field that can deeply penetrate into the target area, any small error that can occur during this procedure can kill the normal healthy tissues.  Siemens makes the metal leafs with a unique chemical element Tungsten for the strength. Tungsten is extremely opaque and radiolucent for the radiation that keeps the leakage levels significantly low during the radiation treatment.  Each leaf in angled position passes individual beams from the multi-leaf collimator to increase the precision and for normal tissue sparing (Ferachi, 2003).
 
Thus, the dose limits are significantly decreased and maximum effect is increased on the targeted area.  Each beam is commissioned with a specific height, weight and depth dependent on the target penetration area based on the chest, lungs, kidneys etc.  To generate the beams with specific precision of height, breadth, and width the electrons are rapidly ionized with linear accelerator generating electromagnetic waves.  Each beam goes through ionization to generate nucleobase anion and build the beam exactly similar to the target area impacted tissue covering including the margins of the tissue.  The linear accelerator basically works as particle accelerator, and generates high velocity acceleration by charging the atomic particles such as electrons or protons by transforming them to ions.  The radioactive source for such external beam therapy can be iridium-192, caesium-137, radium-226, and colbalt-60 all produces the gamma rays (Ferachi, 2003). 
 
 
Internal radiation therapy
 
 
In this therapy the selected localized target with a radiation source is placed inside the body of the patient, for example, the tungsten seeds with radioactive elements are placed inside the tumor of prostate cancer or many other body sites, the tiny radioactive rods stay in the tumor with half-decay radioactive life dependent on the radioactive source chosen and can destroy the tumor cells significantly (Ferachi, 2003). 
 
The internal radiation therapy is performed by directly inserting the radio source into the body at a localized area sometimes also requires a surgery to perform the procedure.  However the high-dose rates cannot exceed 12 gray dose limits, if there’s an error in inserting the right dose into the targeted area, it can destroy the healthy tissues permanently damaging the overall health of the patient.  The radioactive sources considered for internal radiation therapy could be caesium-137, cobalt-30, iridium-192, iodine-125, palladium-103, and ruthenium-106 mostly all producing the gamma rays except tuthenium-106 that produces the beta particles (Ferachi, 2003). 
 
Systematic radiation therapy
 
In this therapy, systematic radiation therapy also known as adjuvant therapy, this is treated as a supplementary therapy session to the patient who already had gone through either external radiation therapy or internal radiation therapy.  The external and international radiation therapies can only ensure the annihilation of the DNA-damaging of the tumor cells to certain extent, there could be still some amount of margin of error that can occur leaving some of the margins of the tumor cell in the body.  In such cases, sending the radiation dose directly to the patient either with the method of injecting iodine-137 or allowing the patient to swallow can work as an additional treatment.  Mostly thyroid cancers are cured with this procedure.  Some of these drugs are sent into the blood directly, the protonation can align and exactly find the antibodies flowing in the blood cells and seek and destroy the tumor cells in the blood without impacting the healthy tissue.  These are all federally approved radiation therapeutic drugs that can be consumed by swallowing the capsules (Ferachi, 2003). 
 
The ethical issues surrounding the radiation therapy involves the potential side effects it can introduce by risking healthy tissue resulting into damage to the tissue.  The following table shows the type of damage it can cause to the normal tissue heightening the ethical, social and political issues in the society.  It is still undetermined which type of radiation therapy completely destroys the tumor cells and increase better survival rates without damaging the healthy tissues.  The social issues in giving the radiation therapy involves creating so many side effects to the patient causing discomfort weeks, months and sometimes lasting for years (Ed, 1993). 
 
On one hand, these technologies can be hailed as groundbreaking technologies to cure the cancer and on the other hand, there is no significant benchmark obtained, as the survival rates from these technologies and the damage done and side effects created are significantly high as opposed to the cure of the cancer.  The price of the multi leaf collimator few years ago was quarter million dollars the installation cost and with unique installation requirements can exceed a million dollars of cost (Ed, 1993). 
 
 
The side effects of radiation therapy on healthy tissue
 
Targeted area with healthy tissue/Related detrimental impact
 
Cranium    -   Sensory perception deficiencies and damage to the cerebral capacity.
   
Back bone  -     Inertia to the whole body.
   
Chest -    Radiolucent inflammation to the lungs.
 
Kidneys -    Nephrosis inflammation to the kidneys.
 
Liver, digestive tissues    -     Ulcerations and inflammation (Ferachi, 2003).           
    
    
    
             
 
 
Conclusion
 
This paper has reviewed the quantum physics, radioactive ionization, big data analytics, hardware, and software blended platforms for performing radiation therapy with the aid of external radiation therapy bolstered by beam-shaping technique with 160 multi leaf collimators.  This paper also defined the measurements for data definitions for radiation therapy to aid big data analytics from clinical trials and sifted through various methods to see how data can be transferred to multiple patients for improving the health complying HIPAA act.  This paper also examined internal radiation therapy by permanent injection of tiny tungsten radioactive rods in the targeted and localized tumor cells, and systemic radiation therapy that allows several federal approved drugs such as ibritumomab tiuxetan, Zevalin.  While the revolutionary technologies created significant advancement for eradication of tumor cells, the cost of the multileaf collimator is significantly high and the side effects can create havoc heightening the ethical, social and political issues, and in some cases can kill the humans and other times leaves the patients with long lasting effects of radioactive decay that can destroy the life gradually in weeks, months or in years if not treated correctly due to human error or software error, hardware error resulting in releasing over dosage limits.  The better survival rates have not been calculated yet as a benchmark and still it’s not determined which type of the therapy can warranty the survival rate of the patient by completely curing the patient without relapses. This is where big data analytics can be the next frontier for radiology.  
 
 
References
 
 
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