{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:29:57Z","timestamp":1784766597548,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:00:00Z","timestamp":1696464000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Knowledge\u2010based planning (KBP) aims to automate and standardize treatment planning. New KBP users are faced with many questions: How much does model size matter, and are multiple models needed to accommodate specific physician preferences? In this study, six head\u2010and\u2010neck KBP models were trained to address these questions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The six models differed in training size and plan composition: The <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> (<jats:italic>n<\/jats:italic>\u00a0=\u00a0203 plans), <jats:italic>KBP<jats:sub>101<\/jats:sub><\/jats:italic> (<jats:italic>n<\/jats:italic>\u00a0=\u00a0101), <jats:italic>KBP<jats:sub>50<\/jats:sub><\/jats:italic> (<jats:italic>n<\/jats:italic>\u00a0=\u00a050), and <jats:italic>KBP<jats:sub>25<\/jats:sub><\/jats:italic> (<jats:italic>n<\/jats:italic>\u00a0=\u00a025) were trained with plans from two head\u2010and\u2010neck physicians. <jats:italic>KBP<jats:sub>A<\/jats:sub><\/jats:italic> and <jats:italic>KBP<jats:sub>B<\/jats:sub><\/jats:italic> each contained <jats:italic>n<\/jats:italic>\u00a0=\u00a0101 plans from only one physician, respectively. An independent set of 39 patients treated to 6000\u20137000\u00a0cGy by a third physician was re\u2010planned with all KBP models for validation. Standard head\u2010and\u2010neck dosimetric parameters were used to compare resulting plans. <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> plans were compared to the clinical plans to evaluate overall model quality. Additionally, clinical and <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> plans were presented to another physician for blind review. Dosimetric comparison of <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> against <jats:italic>KBP<jats:sub>101<\/jats:sub><\/jats:italic>, <jats:italic>KBP<jats:sub>50<\/jats:sub><\/jats:italic>, and <jats:italic>KBP<jats:sub>25<\/jats:sub><\/jats:italic> investigated the effect of model size. Finally, <jats:italic>KBP<jats:sub>A<\/jats:sub><\/jats:italic> versus <jats:italic>KBP<jats:sub>B<\/jats:sub><\/jats:italic> tested whether training KBP models on plans from one physician only influences the resulting output. Dosimetric differences were tested for significance using a paired <jats:italic>t<\/jats:italic>\u2010test (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to manual plans, <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> significantly increased PTV Low D95% and left parotid mean dose but decreased dose cochlea, constrictors, and larynx. The physician preferred the <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic> plan over the manual plan in 20\/39 cases. Dosimetric differences between <jats:italic>KBP<jats:sub>Full<\/jats:sub><\/jats:italic>, <jats:italic>KBP<jats:sub>101<\/jats:sub><\/jats:italic>, <jats:italic>KBP<jats:sub>50<\/jats:sub><\/jats:italic>, and <jats:italic>KBP<jats:sub>25<\/jats:sub><\/jats:italic> plans did not exceed 187\u00a0cGy on aggregate, except for the cochlea. Further, average differences between <jats:italic>KBP<jats:sub>A<\/jats:sub><\/jats:italic> and <jats:italic>KBP<jats:sub>B<\/jats:sub><\/jats:italic> were below 110\u00a0cGy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Overall, all models were shown to produce high\u2010quality plans. Differences between model outputs were small compared to the prescription. This indicates only small improvements when increasing model size and minimal influence of the physician when choosing treatment plans for training head\u2010and\u2010neck KBP models.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14168","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T05:42:31Z","timestamp":1696570951000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of model size and composition on quality of head\u2010and\u2010neck knowledge\u2010based plans"],"prefix":"10.1002","volume":"25","author":[{"given":"Robert","family":"Kaderka","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrin","family":"Dogan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Miami 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