Attention-based Vision Transformer Enables Early Detection of Radiotherapy-Induced Toxicity in Magnetic Resonance Images of a Preclinical Model.

IntroductionEarly identification of patients at risk for toxicity induced by radiotherapy (RT) is essential for developing personalized treatments and mitigation plans. Preclinical models with relevant endpoints are critical for systematic evaluation of normal tissue responses. This study aims to determine whether attention-based vision transformers can classify MR images of irradiated and control mice, potentially aiding early identification of individuals at risk of developing toxicity.MethodC57BL/6J mice (n = 14) were subjected to 66 Gy of fractionated RT targeting the oral cavity, swallowing muscles, and salivary glands. A control group (n = 15) received no irradiation but was otherwise treated identically. T2-weighted MR images were obtained 3-5 days post-irradiation. Late toxicity in terms of saliva production in individual mice was assessed at day 105 after treatment. A pre-trained vision transformer model (ViT Base 16) was employed to classify the images into control and irradiated groups.ResultsThe ViT Base 16 model classified the MR images with an accuracy of 69%, with identical overall performance for control and irradiated animals. The ViT's model predictions showed a significant correlation with late toxicity (r = 0.65, p < 0.01). One of the attention maps from the ViT model highlighted the irradiated regions of the animals.ConclusionsAttention-based vision transformers using MRI have the potential to predict individuals at risk of developing early toxicity. This approach may enhance personalized treatment and follow-up strategies in head and neck cancer radiotherapy.