radiation therapy planners

Abstract: Automated treatment planning (ATP) aims to reduce the unwarranted inter-planner variability of manual planning, while improving treatment quality and efficiency. Most ATP pipelines rely on the prediction of the achievable three-dimensional dose distribution for a given anatomy and the subsequent optimization of machine parameters to reproduce it. Diffusion-based methods are largely slice-wise due to the high dimensionality of radiotherapy data, and assume a one-to-one mapping between anatomy and optimal dose despite the multi-objective nature of treatment planning. They are evaluated on their ability to match reference doses and rarely on their integration in ATP frameworks. We present LaDose, a latent diffusion framework for fully volumetric dose prediction. An autoencoder learned on dose distributions, trained so that perturbed latents decode to plausible doses, compresses dose maps 128-fold and enables 3D diffusion on a single GPU. Prescription values are represented as exact scalar vectors that bypass the image encoder, avoiding resampling and latent compression. Multiscale classifier-free guidance allows for the modulation of clinical trade-offs at inference, without retraining or additional labeled data. On 900 clinically delivered head-and-neck volumetric modulated arc therapy plans from five centers, LaDose reached a median absolute error of 1.18 Gy (1.4--1.8\% of the prescription) and was the only one of six frameworks free of systematic bias with respect to the reference distribution. Guidance scales acted predictably on target coverage and organ-at-risk sparing. Integrated with direct aperture optimization, the pipeline generated plans in 15.2 minutes; in a blinded review, senior clinicians rated 14 of 15 plans acceptable without editing.

Abstract: We adapt the diffeomorphic coarse-to-fine LapIRN architecture for longitudinal whole-body PSMA PET/CT registration in the Learn2Reg 2026 PSMAReg challenge. The method combines affine pre-registration, multi-modal deformable registration, and test-time instance optimization. We further introduce PET biomarker preservation losses for metabolic tumor volume (MTV) and total lesion glycolysis (TLG), including Jacobian-based constraints, and a per-structure rigidity regularization for skeletal structures. The submitted configuration achieved 81.0% DSC and 6.17 mm HD95, with MTV and TLG errors of 3.3% and 3.3%, respectively, on our evaluation protocol. Code is available at https://github.com/koegl/psmareg.

Abstract: Deep learning has enabled substantial advances in oncology, including cancer detection and diagnosis, medical image analysis, tumor characterization, treatment planning, response assessment, and outcome prediction. However, conventional data-driven models often require large annotated datasets, exhibit limited generalization across heterogeneous clinical settings, and lack explicit mechanisms for incorporating the physical, physiological, and biological principles underlying cancer development and treatment. Physics-informed deep learning (PIDL) integrates governing physical laws, mechanistic models, physiological constraints, and domain knowledge into deep learning frameworks, providing a principled approach for learning from sparse, noisy, and heterogeneous oncological data. This review presents a task-oriented synthesis of PIDL methods across oncology, encompassing neural networks, Kolmogorov-Arnold networks, convolutional and vision architectures, neural operators, generative models, and hybrid physics-data-driven frameworks. Their applications are examined across cancer detection and diagnosis, image reconstruction and analysis, tumor characterization, quantitative imaging, tumor progression, treatment response, radiation therapy, treatment planning, and multimodal clinical modeling. Based on the synthesized methodological and application-level evidence, we develop task-optimized PIDL workflows that align the clinical task with appropriate data representations, physical constraints, model architectures, and validation strategies. We further analyze key challenges, including physical-model fidelity, computational scalability, uncertainty quantification, domain generalization, standardized benchmarking, and clinical validation.

Abstract: Purpose: To develop and evaluate TotalSynth, a reusable pretrained framework for whole-body synthetic CT (sCT) generation from MRI and cone-beam CT (CBCT) images. Materials and Methods: In this retrospective technical study, the dataset was assembled between 2020 and 2026 from SynthRAD challenge data, four prostate cohorts, and BIC-MAC. After registration quality control, 1450 of 1800 public challenge pairs were retained; 350 were excluded for insufficient registration quality or major source/CT mismatch. The corpus also included 84 additional prostate MRI/CT and 60 external BIC-MAC MRI/CT cases. Three 5-fold model families were evaluated with image-domain, anatomy-aware, registration-based, and uncertainty metrics. Age and sex were not consistently available across public datasets. Results: The released MRI-to-CT model achieved an overall MAE of 67.49 HU, SSIM of 0.920, and PSNR of 29.28 dB. The CBCT-to-CT model achieved an overall MAE of 53.55 HU, SSIM of 0.939, and PSNR of 32.09 dB. The unified model maintained similar performance on MRI inputs (MAE, 67.68 HU) and CBCT inputs (MAE, 54.22 HU). On external BIC-MAC data, MRI-to-CT MAE was 100.91 HU without fine-tuning and 62.21 HU after fine-tuning. Conclusion: TotalSynth provides reusable MRI- and CBCT-based CT synthesis models with broad anatomical coverage, while external evaluation highlights the need for local validation and optional fine-tuning under domain shift.

Abstract: In proton therapy, plans are typically optimized on a single planning CT, making robustness evaluation essential under anatomical changes. However, current scenarios often rely on simplified perturbations that poorly capture complex, patient-specific variability. We propose SynthRCT, a scalable conditional generative framework for 3D anatomical deformation synthesis. Based on a conditional variational autoencoder, SynthRCT learns a latent deformation space and decodes sampled latent codes into local stationary velocity fields conditioned on an input anatomy. Local fields are assembled into coherent full-volume transformations, enabling memory-scalable generation for large field-of-view CT data. We validate the approach on respiratory 4DCT data with multiple breathing-phase anatomies per subject. SynthRCT enables patient-specific sampling of plausible anatomical transformations beyond predefined robustness scenarios. Code available at: https://github.com/TomasGuija/SynthRCT.