Purpose: Automated scripts and workflows have been implemented in clinics to streamline the planning process, improving efficiency and consistency. However, standardized scripts often lack adaptability for patient-specific scenarios, requiring considerable effort to modify for non-standard cases. To address this, we present an interactive large language model (LLM)–driven approach for flexible workflow automation across radiation oncology tasks. This work presents a proof-of-concept agentic LLM integration that enables flexible, natural-language automation across a broad set of radiotherapy (RT) workflow operations. Methods: An LLM-based assistant system was integrated into the MIM software platform. It includes a recursive MIM workflow, an agentic orchestrator, and coordinated agents: an LLM Consultant for selecting relevant functions, a code generator that compiles executable Java extensions, a Quality Checker for independent verification, and a Knowledge Accumulator that captures and stores valuable insights such as coding patterns, errors, and user preferences. The system uses a prompt-based approach with continuous learning from both successful executions and error corrections to enhance accuracy and adaptability. Its generalizability was validated using 57 realistic simple queries, robustness through repeatability and failure-rate testing, and overall performance through four complex examples addressing advanced clinical tasks across various stages of the adaptive RT workflow. Results: The system effectively replicated standard clinical workflows with high adaptability and flexibility. Early queries required extensive function library accumulation, while later ones mainly reused existing functions. Its multi-agent architecture enabled robust error recovery, with automatic correction loops reducing failure rates from 1% to near zero. Average execution time per query was 13–14 s. All complex examples were successfully implemented in MIM, supporting interactive use, dynamic workflow customization, and straightforward execution. Conclusion: By integrating an interactive AI assistant, the novel LLM-powered tool provides crucial workflow flexibility alongside automation—reducing workflow rigidity, enhancing efficiency, and promising a paradigm shift toward dynamic, patient-specific treatment planning and data management.
Open access
Advanced Radiotherapy Techniques
Advances in Oncology and Radiotherapy
Artificial Intelligence in Healthcare and Education
PURPOSE: Knowledge of the complete axial dose profile f(z), including its long scatter tails, provides the most complete (and flexible) description of the accumulated dose in CT scanning. The CTDI paradigm (including CTDIvol) requires shift-invariance along z (identical dose profiles spaced Sat equal intervals), and is therefore inapplicable to many of the new and complex shift-variant scan protocols, e.g., high dose perfusion studies using variable (or zero) pitch. In this work, a convolustion-based beam model developed by Dixon et al. [Med. Phys. 32, 3712-3728, (2005)] updated with a scatter LSF kernel (or DSF) derived from a Monte Carlo simulation by Boone [Med. Phys. 36, 4547-4554 (2009)] is used to create an analytical equation for the axial dose profile f(z) in a cylindrical phantom. Using f(z), equations are derived which provide the analytical description of Sconventional (axial and helical) dose, demonstrating its physical underpinnings; and likewise for the peak axial dose f(0) appropriate to stationary phantom cone beam CT, (SCBCT). The methodology can also be applied to dose calculations in shift-variant scan protocols. This paper is an extension of our recent work Dixon and Boone [Med. Phys. 37, 2703-2718 (2010)], which dealt only with the properties of the peak dose f(0), its relationship to CTDI, and its appropriateness to SCBCT. METHODS: The experimental beam profile data f(z) of Mori et al. [Med. Phys. 32, 1061-1069 (2005)] from a 256 channel prototype cone beam scanner for beam widths (apertures) ranging from a = 28 to 138 mm are used to corroborate the theoretical axial profiles in a 32 cm PMMA body phantom. RESULTS: The theoretical functions f(z) closely-matched the central axis experimental profile data for all apertures (a = 28 -138 mm). Integration of f(z) likewise yields analytical equations for all the (CTDI-based) dosimetric quantities of conventional CT (including CTDIL itself) in addition to the peak dose f(0) relevant to SCBCT (allowing direct cross-comparison between CT scan modes and mathematical proofs of several hypotheses of practical utility in CT dosimetry). A fast, analytical dose simulator6 is also demonstrated-successfully matching complex dose distributions measured using OSL and film dosimetry. CONCLUSIONS: The model described allows one to obtain analytical functions describing both the primary and scatter components of the axial dose profile. This model (using no empirical functions or adjustable fit parameters) provides a good match to the experimental data, as well as a complete analytical description of dose for both conventional (axial and helical) CT and cone beam CT. An efficient method whereby the complete data set for both modalities can be obtained from a single measurement of either CTDI100 or f(0) is illustrated. This method is also flexible--allowing calculation of heretofore unattainable doses for recently-introduced shift-variant protocols [e.g., variable pitch (irregular scan spacing), variable aperture, shuttle mode acquisition, and mA modulation schemes].
The evolution of radiotherapy in Denmark is traced from its early inception in 1896 to the first three radium centres in 1913-1914, the establishment of which caused a roar of protests among the surgeons of that time. Private initiative pioneered the Radium Foundation which raised money for radium and financed erection of new buildings for the three centres in the 1930's. Radiotherapy became a separate speciality in 1950. The early 1960s saw the introduction of megavoltage therapy and the first promising results from chemotherapeutic management of solid tumors. The consequent referral of patients to centres for non-surgical therapy created a need for two new centres (Aalborg and Herlev) and called for a gradual closing down of decentralized low-voltage treatment at county level. However, the decentralization of health care in 1970 partly reversed this trend and some patients were therefore referred for decentralized treatment at major county hospitals. Such treatment mainly consisted of adjuvant or palliative chemotherapy, though in a few countries palliative therapy was supported by low-voltage therapy. In 1987 the medical speciality of radiotherapy was officially renamed oncology.