{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T05:52:11Z","timestamp":1792129931445,"version":"4.4.0"},"posted":{"date-parts":[[2025,11,25]]},"group-title":"Dentistry and Oral Medicine","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,11,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Purpose\/Objective(s)<\/jats:title>\n                  <jats:p>Osteoradionecrosis of the jaw (ORN) is a severe complication of head and neck cancer (HNC) radiotherapy (RT), significantly impacting patient quality of life. Current dose assessment relies on whole-mandible dosimetry, limiting personalized, tooth-specific region risk evaluation. The lack of standardized methods to document and analyze dose distributions to tooth-bearing regions further hampers dental and maxillofacial decision-making. This study develops and evaluates RADMAP, a (semi-)automated tool for segmenting tooth-based jaw regions, enabling patient- and tooth-specific radiation dose mapping to improve dental dose reporting and ORN risk assessment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods and Materials<\/jats:title>\n                  <jats:p>A total of 736 tooth locations from 23 HNC patients treated with definitive RT were analyzed, including 11 who developed ORN. The RADMAP tool applies an angular ray-based algorithm to automatically segment the mandible and maxilla into 32 tooth-specific jaw regions, with optional manual refinement (semi-automated), outputting radiation dose mapping in both tabular and odontogram formats. Mean dose values from manually contoured tooth roots were compared with RADMAP-segmented alveolar regions (fully and semi-automated). Interobserver agreement among six users was evaluated. Whole-mandible, manual tooth, and tooth-based jaw segment (alveolar and basal) doses were compared between regions with and without ORN development.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Mean dose correlation between RADMAP-segmented alveolar jaw regions and manually segmented tooth roots was high for both fully and semi-automated approaches (R\u00b2 = 0.98, p&lt;0.0001), demonstrating accurate dose estimation. Interobserver agreement showed 95% limits of \u00b12.9 Gy for mandibular alveolar segments, confirming reproducibility. Tooth-based jaw segments showed a significant differentiation in radiation dose for the ORN-positive versus ORN-negative sites (difference in mean dose (DIM): 12.4 \u00b13.7 Gy, p=0.0008), which was not seen when considering the whole-mandible dose (DIM=6.2 \u00b14.3 Gy, p=0.17), demonstrating RADMAP\u2019s promise for improved ORN risk assessment.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>RADMAP enables accurate, tooth-specific dose mapping of the mandible and maxilla, and potential improved ORN risk differentiation beyond whole-mandible dosimetry. Tooth-based dose reporting can personalize treatment, enhance multidisciplinary communication, and support prevention of radiation-related orodental sequelae.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2025.11.23.25340237","type":"posted-content","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T19:00:26Z","timestamp":1764097226000},"source":"Crossref","is-referenced-by-count":3,"title":["Radiation-specific Automated Dosimetric dental, Mandible, and maxilla Annotation for Predicting Periodontal Problems (RADMAP): A semi-automated tool for dosimetric oral risk communication and osteoradionecrosis assessment"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9515-5616","authenticated-orcid":false,"given":"Lisanne V","family":"van Dijk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-6770","authenticated-orcid":false,"given":"Laia","family":"Humbert-Vidan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2096-7732","authenticated-orcid":false,"given":"Erin E","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0233-9035","authenticated-orcid":false,"given":"Ruth A","family":"Aponte Wesson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7553-9674","authenticated-orcid":false,"given":"Luisa E","family":"Jacomina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9166-6286","authenticated-orcid":false,"given":"Renjie","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1020-4966","authenticated-orcid":false,"given":"Mohamed A","family":"Naser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Joo","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4904-531X","authenticated-orcid":false,"given":"He C","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8301-7286","authenticated-orcid":false,"given":"Stephen Y","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5306-9683","authenticated-orcid":false,"given":"Muhammad","family":"Walji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4135-3246","authenticated-orcid":false,"given":"Max JH","family":"Witjes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0239-9807","authenticated-orcid":false,"given":"Matthew S.","family":"Katz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S","family":"Chambers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-3994","authenticated-orcid":false,"given":"Clifton D","family":"Fuller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6762-6807","authenticated-orcid":false,"given":"Amy C","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2025112702100617000_2025.11.23.25340237v1.1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.14.6647"},{"key":"2025112702100617000_2025.11.23.25340237v1.2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.2017.121"},{"key":"2025112702100617000_2025.11.23.25340237v1.3","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.02750"},{"key":"2025112702100617000_2025.11.23.25340237v1.4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.01"},{"key":"2025112702100617000_2025.11.23.25340237v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2011.03.003"},{"key":"2025112702100617000_2025.11.23.25340237v1.6","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.ijrobp.2021.04.042","article-title":"Normal Tissue Complication Probability (NTCP) Prediction Model for Osteoradionecrosis of the Mandible in Patients With Head and Neck Cancer After Radiation Therapy: Large-Scale Observational Cohort. 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