{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:16:12Z","timestamp":1791915372378,"version":"4.3.4"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The electronic compensation (ECOMP) technique for breast radiation therapy provides excellent dose conformity and homogeneity. However, the manual fluence painting process presents a challenge for efficient clinical operation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To facilitate the clinical treatment planning automation of breast radiation therapy, we utilized reinforcement learning (RL) to develop an auto\u2010planning tool that iteratively edits the fluence maps under the guidance of clinically relevant objectives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>With institutional review board (IRB) approval, 70 patients treated with 6MV tangential photon beams with ECOMP technique were retrospectively collected and included in this study (20\/50 for training\/testing). Each pixel in the fluence map was assigned a reinforcement learning agent to perform independent action. Beam\u2010eye\u2010view projected dose profiles were generated to form state information as the input of the RL network. By predicting the Q value, pixel\u2010wise actions were selected to modify specific pixel value in the fluence maps to improve overall plan quality. After dose calculation, reward signal calculated from the variation of target coverage and dose homogeneity was fed back to the RL framework and used to update network parameters. The RL generated plans were evaluated with dose distribution and dosimetric endpoints (i.e., Breast PTV V90%, Breast PTV V95%, Breast PTV V105%, Lung V20\u00a0Gy, Heart V5\u00a0Gy, Dmax) and compared with clinical plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The RL agent took around 90 s to generate a ECOMP treatment plan. The RL plans exhibited plan quality comparable to clinical plans in terms of isodose distribution and dosimetric endpoints. The mean Breast PTV V95%, Breast PTV V105% of RL plans are  and , compared to  and  cc of clinical plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The developed RL framework efficiently generates breast ECOMP plans with clinical acceptable plan quality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.17615","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T22:45:11Z","timestamp":1737672311000},"page":"2015-2024","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Breast radiation therapy fluence painting with multi\u2010agent deep reinforcement learning"],"prefix":"10.1002","volume":"52","author":[{"given":"Yang","family":"Dongrong","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xinyi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoo","family":"Sua","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blitzblau","family":"Rachel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McDuff","family":"Susan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephens","family":"Sarah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Segars","family":"Paul","sequence":"additional","affiliation":[{"name":"Department of Radiology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Q Jackie","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University  North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2022.08.010"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19323"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3857\/roj.2020.00619"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.04.026"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jrr\/rrs064"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2023.100492"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2021.01.006"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phro.2024.100539"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/acm2.13228"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.meddos.2018.12.001"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artmed.2014.12.012"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.11.006"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2017.11.007"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa066099"},{"key":"e_1_2_8_16_1","unstructured":"ZhangJ GeY WangC et\u00a0al.Artificial Intelligence\u2010Driven Pancreas Stereotactic Body Radiation Therapy (SBRT) Treatment Planning. 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