{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T20:34:31Z","timestamp":1770582871669,"version":"3.49.0"},"reference-count":16,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"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":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The treatment planning process from segmentation to producing a deliverable plan is time\u2010consuming and labor\u2010intensive. Existing solutions automate the segmentation and planning processes individually. The feasibility of combining auto\u2010segmentation and auto\u2010planning for volumetric modulated arc therapy (VMAT) for rectal cancers in an end\u2010to\u2010end process is not clear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To create and clinically evaluate a complete end\u2010to\u2010end process for auto\u2010segmentation and auto\u2010planning of VMAT for rectal cancer requiring only the gross tumor volume contour and a CT scan as inputs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patient scans and data were retrospectively selected from our institutional records for patients treated for malignant neoplasm of the rectum. We trained, validated, and tested deep learning auto\u2010segmentation models using nnU\u2010Net architecture for clinical target volume (CTV), bowel bag, large bowel, small bowel, total bowel, femurs, bladder, bone marrow, and female and male genitalia. For the CTV, we identified 174 patients with clinically drawn CTVs. We used data for 18 patients for all structures other than the CTV. The structures were contoured under the guidance of and reviewed by a gastrointestinal (GI) radiation oncologist. The predicted results for CTV in 35 patients and organs at risk (OAR) in six patients were scored by the GI radiation oncologist using a five\u2010point Likert scale. For auto\u2010planning, a RapidPlan knowledge\u2010based planning solution was modeled for VMAT delivery with a prescription of 25\u00a0Gy in five fractions. The model was trained and tested on 20 and 34 patients, respectively. The resulting plans were scored by two GI radiation oncologists using a five\u2010point Likert scale. Finally, the end\u2010to\u2010end pipeline was evaluated on 16 patients, and the resulting plans were scored by two GI radiation oncologists.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 31 of 35 patients, CTV contours were clinically acceptable without necessary modifications. The CTV achieved a Dice similarity coefficient of 0.85 (\u00b10.05) and 95% Hausdorff distance of 15.25 (\u00b15.59)\u00a0mm. All OAR contours were clinically acceptable without edits, except for large and small bowel which were challenging to differentiate. However, contours for total, large, and small bowel were clinically acceptable. The two physicians accepted 100% and 91% of the auto\u2010plans. For the end\u2010to\u2010end pipeline, the two physicians accepted 88% and 62% of the auto\u2010plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrated that the VMAT treatment planning technique for rectal cancer can be automated to generate clinically acceptable and safe plans with minimal human interventions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.14259","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T08:01:10Z","timestamp":1707292870000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Automatic end\u2010to\u2010end VMAT treatment planning for rectal cancers"],"prefix":"10.1002","volume":"25","author":[{"given":"Kai","family":"Huang","sequence":"first","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences  Houston Texas USA"},{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan B.","family":"Ludmir","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lifei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance A.","family":"Owens","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences  Houston Texas USA"},{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean Gumma\u2010De La","family":"Vega","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack","family":"Duryea","sequence":"additional","affiliation":[{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8863-841X","authenticated-orcid":false,"given":"Yao","family":"Zhao","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences  Houston Texas USA"},{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinru","family":"Chen","sequence":"additional","affiliation":[{"name":"The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences  Houston Texas USA"},{"name":"Department of Radiation Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Fuentes","sequence":"additional","affiliation":[{"name":"Department of Imaging Physics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos E.","family":"Cardenas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Alabama at Birmingham  Birmingham Alabama 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