ArticleJournal of applied clinical medical physics2026
Human-like AI-based auto-field-in-field whole-brain radiotherapy treatment planning with conversation large language model feedback.
Article in Journal of applied clinical medical physics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhole-brain radiotherapy (WBRT) is a common treatment due to its simplicity and effectiveness. While automated Field-in-Field (Auto-FiF) functions assist WBRT planning in modern treatment planning systems, it still requires manual approaches for optimal plan generation including patient-specific hyperparameters definition and plan refinement based on quality feedback. PURPOSE: This study introduces an automated WBRT planning pipeline that integrates a deep learning (DL) Hyperparameter Prediction model for patient-specific parameter generation and a large-language model (LLM)-based conversational interface for interactive plan refinement.
methodsThe Hyperparameter Prediction module was trained on 55 WBRT cases using geometric features of clinical target volume (CTV) and organs at risk (OARs) to determine optimal Auto-FiF settings in RayStation treatment planning system. Plans were generated under predicted hyperparameters. For cases in which the generated plan was suboptimal, quality feedback via voice input was captured by a Conversation module, transcribed using Whisper, and interpreted by GPT-4o to adjust planning settings. Plan quality was evaluated in 15 independent cases using clinical metrics and expert review, and model explainability was supported through analysis of feature importance.
resultsFourteen of 15 DL-generated plans were clinically acceptable. Normalized to identical CTV D95% as the clinical plans, the DL-generated and clinical plans showed no statistically significant differences in doses to the eyes, lenses, or CTV dose metrics D1% and D99%. The DL-based planning required under 1 min of computation and achieved total workflow execution in approximately 7 min with a single mouse click, compared to 15 min for manual planning. In cases requiring adjustment, the Conversational module successfully improved dose conformity and hotspot reduction.
conclusionsThe proposed system improves planning efficiency while maintaining clinically acceptable plan quality. It demonstrates the feasibility of combining DL-based hyperparameter prediction with LLM interaction for streamlined, high-quality WBRT planning.
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