Clinical implementation and evaluation of an artificial intelligence-driven one-click automatic planning system for functional lung avoidance radiotherapy

Why clinicians should know about it

• Picked for Medical Physics (paper of the day, 21 September 2026): One-click auto-planning reduces planning time, dosimetric evaluation

Abstract

PURPOSE: To advance the clinical application of an artificial intelligence-driven automatic planning system for functional lung avoidance radiotherapy (AP-FLART) through clinical implementation and comprehensive evaluation. METHODS AND MATERIALS: AP-FLART integrates dosimetric score-based beam angle selection, multi-modality-guided dose prediction, and function-guided dose mimicking. The system was enhanced and implemented within the clinical treatment planning system RayStation. Clinical performance and potential benefits were assessed using a test dataset comprising 33 lung cancer patients who underwent SPECT ventilation or perfusion imaging and lung radiotherapy. Dosimetric metrics and normal tissue complication probabilities of automatic FLART plans were compared with manual conventional radiotherapy (ConvRT) and FLART plans created by an experienced planner. Three clinicians conducted blinded reviews comparing the automatic and manual FLART plans. RESULTS: Compared to manual ConvRT plans, automatic FLART plans significantly reduced high-function lung mean dose by 15.1%. Among FLART-benefiting patients, automatic FLART plans reduced the probability of grade ≥2 radiation pneumonitis by 6.25 percentage points (27%), while maintaining comparable probabilities for other side effects. The estimated clinical benefits are similar to those of manual FLART plans. Blinded reviews indicated that 87.9% of automatic FLART plans were clinically acceptable without modification, and 68.7% were rated as comparable (38.4%) or superior (30.3%) to manual FLART plans. Furthermore, AP-FLART reduced planning time from 2-3 hours for manual FLART planning to approximately 8 minutes. CONCLUSIONS: A clinically viable, one-click auto-planning system for FLART (AP-FLART) has been successfully implemented and comprehensively evaluated. AP-FLART shows considerable promise for improving the efficiency and reducing workload demands of FLART planning and advancing the broader clinical adoption of FLART.

Abstract as published, via PubMed.