Technical Notes
Implementation verification documentation (tests, constraints, and evidence basis) for all RLT Platform calculators.
Validation Summary
All platform calculators are verified through automated testing to confirm implementation correctness. Tests verify that code behavior matches stated formulas, clinical thresholds, and expected directional relationships. This validation confirms technical accuracy but does not replace clinical validation or physician judgment.
What We Test
Baseline Verification
Every calculator is tested with standard clinical inputs to verify results render correctly and match expected ranges.
- ✓Result display visibility
- ✓Value ranges within clinical norms
- ✓Chart and table generation
Sensitivity Testing
Each input is varied independently to confirm outputs change in the clinically expected direction.
- ✓Higher activity → higher dose
- ✓Lower eGFR → higher nephrotoxicity risk
- ✓Higher Gleason → higher risk category
Edge Case Testing
Boundary values and extreme inputs are tested to ensure proper handling and conservative capping.
- ✓Minimum/maximum input values
- ✓Threshold boundaries (e.g., PSA at 10, 20)
- ✓Conservative caps enforced
100-Case Stratified Testing
Randomized inputs across the full clinical range to detect edge cases and regression issues.
- ✓Seeded random for reproducibility
- ✓All major input combinations covered
- ✓15/15 calculator modules covered
Module Coverage
| Calculator | Test Methods | Tests | Key Validations | Status |
|---|---|---|---|---|
| Organ Dosimetry | Unit + edge + 100-case | 7 | Kidney/salivary doses, cycle scaling, activity effects | ✓ |
| Voxel Dosimetry | Unit + behavior + 100-case | 6 | S-value calculations, SUV effects, weight scaling, BED | ✓ |
| Serial Dosimetry | Unit + behavior + 100-case | 5 | Time-activity curves, mono/bi-exponential models, organ mass | ✓ |
| AE Predictor | Unit + behavior + 100-case | 7 | Xerostomia, nephrotoxicity, hematologic risk, conservative caps | ✓ |
| PSA Trajectory | Unit + behavior + 100-case | 5 | Nadir prediction, decline %, response types, monitoring schedule | ✓ |
| Response Tool | Unit + edge + 100-case | 6 | RECIST 1.1 criteria, PCWG3 2+2 rule, overall response | ✓ |
| Risk Stratification | Unit + 100-case | 5 | PSA50/PSA90 rates, PFS estimation, risk factor adjustments | ✓ |
| Staging (NCCN/TNM) | Unit + edge + 100-case | 7 | Risk categories, grade groups, response assessments | ✓ |
| Prostate Cancer ADT | Unit + 100-case | 30 | NCCN/STAMPEDE/LATITUDE/CAPRA scoring, drug selection, contraindications | ✓ |
| Cost-Effectiveness | Unit + edge + 100-case | 9 | ICER calculations, QALY modeling, region/comparator effects | ✓ |
| Trial Simulation | Unit + 100-case | 4 | VISION trial response curves, PSA/SUV effects | ✓ |
| Cohort Simulator | Unit + edge + 100-case | 5 | Power calculations, cohort size effects, dropout rates | ✓ |
| Response Estimator | Unit + edge + 100-case | 5 | Response probability, feature importance, uncertainty bounds | ✓ |
| Genomic Stratification | Unit + edge + 100-case | 6 | HRR mutation effects, BRCA status, therapy selection | ✓ |
| Consensus Pathways | Unit + edge + 100-case | 5 | Guideline concordance, treatment sequencing | ✓ |
Scientific Validation
Dosimetry Calculations
- S-values: Lu-177 MIRD phantom data (ICRP 133, OLINDA/EXM)
- Half-life: Physical 6.647 days; biological organ-specific
- BED formula: Dale model for continuous low-dose-rate irradiation
- α/β ratios: Kidneys 2.6 Gy, salivary 3 Gy, tumor 10 Gy
Clinical Decision Rules
- RECIST 1.1: 30% decrease for PR, 20%+5mm increase for PD
- PCWG3: 2+2 rule for bone progression confirmation
- NCCN: PSA + Gleason + T-stage scoring algorithm
- LATITUDE/STAMPEDE: High-volume disease criteria
Data Sources: S-values loaded from data/s-values-lu177.json containing MIRD reference
organ self-dose and cross-dose values. Clinical thresholds match published guidelines (NCCN 2024, ESMO 2023).
Constraints & Limitations
Input Ranges
- • PSA: 0.1 – 10,000 ng/mL
- • Administered activity: 1 – 20 GBq
- • Patient weight: 40 – 200 kg
- • Age: 18 – 100 years
- • eGFR: 15 – 150 mL/min/1.73m²
- • Bone metastases: 0 – 100 lesions
Not Validated For
- • Neuroendocrine prostate cancer (NEPC)
- • Pediatric patients
- • Non-PSMA-expressing tumors
- • Combination with external beam RT dosimetry
- • Real-time treatment guidance
- • Regulatory submission data
Conservative Caps Applied
- Hematologic AE risk: max 43%
- Xerostomia risk: max 9%
- Nephrotoxicity risk: max 6%
Reference Populations
- VISION trial cohort (mCRPC)
- TheraP trial data
- ICRP reference adult male
Drug Safety Checks
- Abiraterone: cardiac/liver contraindications
- Enzalutamide: seizure history
- GnRH agonists: spinal cord compression
Production Readiness Statement
This platform has been verified for implementation correctness within declared assumptions and input ranges. All 112 automated tests pass, covering 17/17 modules with 100-case stratified testing on all 15 clinical calculators.
Important: This validation confirms the code correctly implements stated formulas and logic. It does not constitute clinical validation, regulatory approval, or substitute for physician judgment. All outputs should be verified against published evidence and institutional protocols before clinical use.