Human-like AI-based Auto-Field-in-Field Whole-Brain Radiotherapy Treatment Planning With Conversation Large Language Model Feedback

TL;DR

This paper presents an automated whole-brain radiotherapy planning system that combines deep learning for patient-specific parameter prediction with a conversational AI interface for interactive plan refinement, significantly reducing planning time.

Contribution

It introduces a novel integrated pipeline using deep learning and large-language models to automate and improve WBRT planning with minimal manual intervention.

Findings

14 out of 15 plans were clinically acceptable.

DL plans matched clinical plans in key dose metrics.

Workflow time reduced to approximately 7 minutes.

Abstract

Whole-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. 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. The 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. Fourteen 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 minute of computation and achieved total workflow execution in approximately 7 minutes with a single mouse click, compared to 15 minutes for manual planning. In cases requiring adjustment, the Conversational module successfully improved dose conformity and hotspot reduction.