Clinical Experience With Machine Learning-Based Automated Treatment Planning for Whole Breast Radiation Therapy.



The machine learning-based automated treatment planning (MLAP) tool has been developed and evaluated for breast radiation therapy planning at our institution. We implemented MLAP for patient treatment and assessed our clinical experience for its performance.

Methods and materials

A total of 102 patients of breast or chest wall treatment plans were prospectively evaluated with institutional review board approval. A human planner executed MLAP to create an auto-plan via automation of fluence maps generation. If judged necessary, a planner further fine-tuned the fluence maps to reach a final plan. Planners recorded the time required for auto-planning and manual modification. Target (ie, breast or chest wall and nodes) coverage and dose homogeneity were compared between the auto-plan and final plan.


Cases without nodes (n = 71) showed negligible (<1%) differences for target coverage and dose homogeneity between the auto-plan and final plan. Cases with nodes (n = 31) also showed negligible difference for target coverage. However, mean ± standard deviation of volume receiving 105% of the prescribed dose and maximum dose were reduced from 43.0% ± 26.3% to 39.4% ± 23.7% and 119.7% ± 9.5% to 114.4% ± 8.8% from auto-plan to final plan, respectively, all with P ≤ .01 for cases with nodes (n = 31). Mean ± standard deviation time spent for auto-plans and additional fluence modification for final plans were 12.1 ± 9.3 and 13.1 ± 12.9 minutes, respectively, for cases without nodes, and 16.4 ± 9.7 and 26.4 ± 16.4 minutes, respectively, for cases with nodes.


The MLAP tool has been successfully implemented for routine clinical practice and has significantly improved planning efficiency. Clinical experience indicates that auto-plans are sufficient for target coverage, but improvement is warranted to reduce high dose volume for cases with nodal irradiation. This study demonstrates the clinical implementation of auto-planning for patient treatment and the significant importance of integrating human experience and feedback to improve MLAP for better clinical translation.






Published Version (Please cite this version)


Publication Info

Yoo, Sua, Yang Sheng, Rachel Blitzblau, Susan McDuff, Colin Champ, Jay Morrison, Leigh O'Neill, Suzanne Catalano, et al. (2021). Clinical Experience With Machine Learning-Based Automated Treatment Planning for Whole Breast Radiation Therapy. Advances in radiation oncology, 6(2). p. 100656. 10.1016/j.adro.2021.100656 Retrieved from

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Sua Yoo

Associate Professor of Radiation Oncology

Patient positioning verification for radiation therapy using OBI/CBCT; Treatment planning for breast cancer radiotherapy;


Yang Sheng

Assistant Professor of Radiation Oncology

My research interest focuses on machine learning and AI application in radiation oncology treatment planning, including prostate cancer, head-and-neck cancer and pancreatic cancer etc.


Rachel Catherine Blitzblau

Associate Professor of Radiation Oncology

Susan Grams Robison McDuff

Assistant Professor of Radiation Oncology

Fang-Fang Yin

Gustavo S. Montana Distinguished Professor of Radiation Oncology

Stereotactic radiosurgery, Stereotactic body radiation therapy, treatment planning optimization, knowledge guided radiation therapy, intensity-modulated radiation therapy, image-guided radiation therapy, oncological imaging and informatics


Qingrong Wu

Professor of Radiation Oncology

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