Martin Kraus

Isabella Poles, Simon Arberet, Riqiang Gao et al.

Volumetric Modulated Arc Therapy (VMAT) is a cornerstone of modern radiation therapy, enabling highly conformal tumor irradiation and healthy-tissue sparing. Yet, its planning solves inverse and nested optimization for multi-leaf collimators, monitor units and dose parameters, while enforcing their consistency to ensure mechanical deliverability. Nevertheless, this process often requires repeated re-optimization when treatment configurations change, resulting in substantial planning time per patient. To address these problems, we present a diffusion-driven Learning-to-Optimize (L2O) method for end-to-end VMAT planning. A distribution-matching distilled diffusion model learns a clinically feasible manifold of fluence maps, enabling their one-shot generation. On top of this, an LSTM-based L2O module learns gradient update dynamics to swiftly refine fluence maps toward prescribed dose objectives during inference. Experimental results on clinical and public prostate cancer cohorts demonstrate improved planning efficiency, flexibility, and machine deliverability over currently available end-to-end VMAT planners.

Yuhan Wang, Zihan Li, Han Liu et al.

Voxel-wise dose prediction is a critical yet challenging task in practical radiotherapy (RT) planning, as bespoke models trained from scratch often struggle to generalize across diverse clinical settings. Meanwhile, generative models trained on billion-scale datasets from vision domains have achieved impressive performance. Herein, we propose DiffKT3D, a unified Any2Any 3D diffusion framework that leverages prior knowledge from pretrained video diffusion models for efficient and clinically meaningful dose prediction. To enable flexible conditioning across multiple clinical modalities (CT, anatomical structures, body, beam settings, etc.), we introduce an Any2Any conditional paradigm utilizing modality-specific embeddings without cross-attention overhead. Further, we design a novel reinforcement learning (RL) post-training mechanism guided by a clinically-informed Scorecard explicitly tailored to institutional treatment preferences. Compared with winner of GDP-HMM challenge, DiffKT3D sets a new state-of-the-art in dose prediction by reducing voxel-level MAE from 2.07 to 1.93. In addition, DiffKT3D achieves superior image quality and preference match. These results demonstrate that transferring diffusion priors via modality-aware conditioning and clinically aligned RL post-training can provide a robust and generalizable solution for RT planning across various clinical scenarios.

Simon Arberet, Riqiang Gao, Martin Kraus et al.

Artificial intelligence-based radiation therapy (RT) planning has the potential to reduce planning time and inter-planner variability, improving efficiency and consistency in clinical workflows. Most existing automated approaches rely on multiple dose evaluations and corrections, resulting in plan generation times of several minutes. We introduce AIRT (Artificial Intelligence-based Radiotherapy), an end-to-end deep-learning framework that directly infers deliverable treatment plans from CT images and structure contours. AIRT generates single-arc VMAT prostate plans, from imaging and anatomical inputs to leaf sequencing, in under one second on a single Nvidia A100 GPU. The framework includes a differentiable dose feedback, an adversarial fluence map shaping, and a plan generation augmentation to improve plan quality and robustness. The model was trained on more than 10,000 intact prostate cases. Non-inferiority to RapidPlan Eclipse was demonstrated across target coverage and OAR sparing metrics. Target homogeneity (HI = 0.10 $\pm$ 0.01) and OAR sparing were similar to reference plans when evaluated using AcurosXB. These results represent a significant step toward ultra-fast standardized RT planning and a streamlined clinical workflow.