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Artificial intelligence (AI) may improve risk prediction and RT planning; however, its role in RT-associated CVT remains unclear. This study aimed to systematically evaluate AI applications and study quality in this field.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A PRISMA-guided systematic review of PubMed, Ovid EMBASE, Cochrane Library, and Web of Science was conducted through October 1, 2025. Eligible studies included original human research in English applying AI to CVT or imaging in cancer populations receiving RT. Predictive and imaging studies were evaluated using TRIPOD\u2009+\u2009AI\/PROBAST and CLAIM\/QUADAS-2, respectively. Exploratory meta-analysis of performance metrics was conducted where feasible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-five studies were included, comprising AI prediction models (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200931, 48%) and cardiovascular imaging applications (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200934, 52%). Deep learning was the most common approach (45\/65, 69%) and demonstrated the highest predictive performance (median AUC\u2009=\u20090.82; median sensitivity\u2009=\u20090.83). Calibration assessment (3\/31, 10%) and external validation (6\/31, 19%) were limited. Meta-analysis demonstrated an overall predictive model accuracy of 0.83 (95% CI: 0.77\u20130.87). Imaging models performed well for larger cardiac structures (overall median DSC\u2009=\u20090.85, range: 0.76\u20130.94), while coronary artery segmentation remained challenging. Average TRIPOD\u2009+\u2009AI and CLAIM adherence were 79% and 71%, respectively. Most predictive (97%) and imaging (82%) studies were rated at high risk-of-bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AI shows promise for RT-associated CVT prediction and imaging but is underdeveloped for routine clinical implementation. Heterogeneity, limited validation, and methodological limitations highlight the need for standardized endpoints, external validation, and prospective clinical evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40959-026-00528-5","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T03:00:10Z","timestamp":1781838010000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A systematic review of artificial intelligence in radiotherapy associated cardiovascular toxicity"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-4635","authenticated-orcid":false,"given":"Vivian","family":"Salama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon M.","family":"Godinich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathaniel","family":"Dunham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijin","family":"Wen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Schmidlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peyton M.","family":"Lilly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Ryckman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon Alfredo","family":"Siochi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashkan","family":"Emadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Bianco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George G.","family":"Sokos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond R.","family":"Raylman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Clump","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina F.","family":"Hanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip M.","family":"Pifer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"528_CR1","first-page":"100479","volume":"48","author":"G Echefu","year":"2024","unstructured":"Echefu G, Shah R, Sanchez Z, Rickards J, Brown SA. 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The company has not provided financial support for this work and has no role in the design, execution or interpretation of this study. CMB has served on speaker bureaus for Bristol Myers Squibb and Pfizer, including disease state education related to ATTR cardiomyopathy. He has also received research support from Pfizer which is not related to this work. PMP has served as a consultant for Varian Medical Systems (speaker in brachytherapy-related activities), with salary support received, and no relation with this work. JR has served as a consultant and advisory board member for Elekta and Atrium OS. He also reports ownership of stock options in Aitrium OS. No additional commercial or industry relationships are reported. The remaining authors have nothing to disclose.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"110"}}