{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:17:41Z","timestamp":1792513061455,"version":"4.5.0"},"reference-count":27,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01DE033512"],"award-info":[{"award-number":["R01DE033512"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01CA272991"],"award-info":[{"award-number":["R01CA272991"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Swallowing dysfunction after radiotherapy (RT) is often linked to pharyngeal mucosal damage. This study aimed to develop a dysphagia\u2010optimized knowledge\u2010based planning (DO\u2010KBP) model by incorporating individual pharyngeal constrictors (DO\u2010KBP) into an existing model, which was based on a conventional approach of including pharynx as a single structure during treatment planning (P\u2010KBP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      The P\u2010KBP model was trained on 175 head and neck cases with the pharynx contoured as a single organ. The DO\u2010KBP model included 36 additional oropharynx cases (\u223c20% increase) with individual pharyngeal constrictors delineated. Both models were evaluated on 25 test patients. Treatment plans generated by each model were normalized to planning\u2010target\u2010volume (PTV) coverage (D95%), and dosimetric parameters were compared using two\u2010tailed paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests. A blind physician review assessed clinical preference.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The DO\u2010KBP model was able to significantly reduce the mean dose to the inferior constrictor (36.52\u00a0\u00b1\u00a09.87\u00a0Gy to 19.52\u00a0\u00b1\u00a06.23\u00a0Gy) and superior\/middle constrictors (51.89\u00a0\u00b1\u00a06.31\u00a0Gy to 47.46\u00a0\u00b1\u00a06.12\u00a0Gy) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05) with the addition of 36 high\u2010quality treatment plans. Though statistically significant increases in mean dose were observed for the spinal cord PRV (D0.03cc), cochlea, mandible, and left brachial plexus with the DO\u2010KBP model, these differences were small in magnitude and remained within clinical goals. However, these differences were small in magnitude and remained within clinical goals. Plan homogeneity was equivalent (HI\u00a0=\u00a00.09). The DO\u2010KBP plans were preferred in blinded review.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Targeted addition of a small number of cases with individually contoured constrictors to an existing model significantly improved sparing of swallowing structures, without compromising overall plan quality or increasing organs\u2010at\u2010risk (OAR) doses beyond clinical thresholds, highlighting that modest, focused data augmentation can yield clinically meaningful gains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70519","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:21:47Z","timestamp":1773004907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dysphagia optimized knowledge\u2010based planning for head and neck cancer"],"prefix":"10.1002","volume":"27","author":[{"given":"Tu","family":"Thi","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"},{"name":"Medical Dosimetry Program Southern Illinois University  Carbondale Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3781-6666","authenticated-orcid":false,"given":"Kirk","family":"Luca","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Roper","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Emory University  Atlanta Georgia 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