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Preface
Articial Intelligence (AI) is playing a transformative role in healthcare, particularly in the eld of radiation therapy (RT). Adaptive radiation therapy (ART), a complex and dynamic treatment approach that incorporates feedback mechanisms to account for patient-specic anatomic, biological, and functional changes during the course of treatment, holds signicant promise. The integration of AI into ART heralds a new era of enhanced precision, efciency, and personalization in cancer care.
This book, Articial Intelligence in Adaptive Therapy, is a comprehensive and timely exploration of how AI technologies are reshaping the landscape of ART from data acquisition and image processing to decision-making and treatment delivery. This book is designed to serve as a foundational and forward-looking resource for medical physicists, radiation oncologists, researchers, and clinicians interested in understanding and leveraging the power of AI in RT and ART.
The book begins with the fundamental concepts of AI (chapter 1) and gradually builds toward advanced clinical applications (section II) in ART, and clinical applications in ART (section III), providing a structured and in-depth view of the entire AI–ART ecosystem.
Early chapters lay the groundwork by introducing AI in the context of radiation therapy, including imaging technologies, big data utilization, image registration and segmentation, dose prediction, and motion monitoring, etc. Subsequent chapters dive into the technical pillars of each step of the ART workow. This book also addresses the growing role of AI in quality assurance, treatment adaptation, response prediction, and clinical trials.
Recognizing the real-world challenges of implementation, later chapters (section III) provide critical discussions on ethical, regulatory, safety, and training considerations. The book concludes with a vision of recent advances and the future of AI-augmented ART, highlighting promising research directions and emerging innovations.
Our goal is to equip clinicians, researchers, and trainees with the knowledge to critically engage with AI technologies and thoughtfully incorporate them into clinical practice. As adaptive therapy continues to evolve, AI will be a key enabler of innovation, efciency, and improved patient outcomes. Whether you are new to the eld or an experienced practitioner seeking to stay current, this book aims to inform, inspire, and guide your journey through the rapidly evolving world of AI­powered adaptive therapy. We hope this book will serve as both a guide and a catalyst for further advancement in this exciting and fast-moving eld.
xx

Foreword

In the ever-advancing eld of radiation oncology, the integration of articial intelligence (AI) promises transformative change, particularly in the realm of adaptive radiation therapy (ART). The recent advances in AI have come just in time to bring ART to clinical reality and represents a signicant leap forward in personalizing treatment plans, optimizing radiation therapy delivery, and improving patient outcomes. Articial Intelligence in Adaptive Radiation Therapy serves as the rst comprehensive guide to understand and apply AI-driven techniques in radiation oncology as they relate to ART, providing a deep dive into both the theoretical underpinnings and practical implementations of the topic.
The chapters within this book cover a wide array of topics, from the basics of AI and its introduction into radiation therapy to more advanced applications of AI­driven imaging, treatment planning, and real-time adaptation. Each chapter is meticulously crafted by leading experts in the eld, offering insights into how AI can enhance every step of the ART workow, from simulation to quality assurance. The discussions are grounded in the latest research and clinical practice, making this book an invaluable resource for clinicians, researchers, and trainees alike.
As you dive into the pages of Articial Intelligence in Adaptive Radiation Therapy, you will not only discover the profound impact that AI is having on the highly technical eld of radiation oncology, but also in the way we approach cancer treatment in general. The innovations discussed here not only push the boundaries of what is possible in radiation oncology, but also pave the way for future technological advancements that will continue to enhance the precision and effectiveness of radiation oncology and cancer care.
This book is much more than just a compilation of knowledge; it is a testament to the collaborative efforts of scientists, clinicians, and engineers who are dedicated to advancing the eld of radiation therapy. It is hoped that the insights shared in these pages will inspire further exploration and innovation, ultimately leading to better outcomes for cancer patients worldwide.
Welcome to the future of radiation therapywhere AI plays a central role in shaping the next generation of cancer treatment.
Michael Steinberg, MD
Professor and Chair
Department of Radiation Oncology
David Geffen School of Medicine at UCLA
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Acknowledgments

The editors gratefully acknowledge the contributions of all chapter authors, whose expertise and dedication have been essential to the creation of this book. Their collective scholarship has brought together a comprehensive and timely perspective on this rapidly evolving eld.
We extend our sincere appreciation to the reviewers, whose thoughtful and constructive feedback greatly enhanced the scientic rigor and clarity of the work. We are also thankful to the IOP Publishing team for their consistent guidance and support throughout the publication process.
Our deepest appreciation to our families for their patience, understanding and unwavering support throughout the preparation of this book.
xxii

Editor biographies

Yi Wang

Dr Yi Wang is a medical physicist from the Department of
Radiation Oncology at Massachusetts General Hospital (MGH) and an Assistant Professor of Radiation Oncology at Harvard Medical School (HMS) in Boston, MA, USA. He earned his BEng in Automation from the Beijing University of Aeronautics and Astronautics (China) in 2002, and his MS and PhD in Biomedical Engineering from the University of Michigan (Ann
Arbor, MI, USA) in 2004 and 2009, respectively. He completed the three-year residency in therapeutic medical physics at the Harvard Medical Physics Residency Program in 2012, including a year of postdoctoral fellowship at the Francis H Burr Proton Therapy Center at MGH. Since then, he has been working as a faculty physicist in the Department of Radiation Oncology at MGH. Locally, he leads an AI Lab and serves as the Director of the Mass General Brigham (MGB) Undergraduate Fellowship Program in Medical Physics. As an internation­ally recognized expert on AI for radiation therapy, he serves in multiple AI-related committees, task groups, and working groups in the American Association of Physicists in Medicine (AAPM), including the Machine Intelligence Subcommittee, Ad Hoc Advisory Committee on Articial Intelligence Boot Camps, the Vice Chair of Task Group 384 (Clinical Implementation of Automated Segmentation for Adaptive Radiation Therapy), and the Chair of the Working Group on Generative Articial Intelligence. He has authored and co-authored over 40 journal articles, conference papers, and book chapters.

X. Sharon Qi

X. Sharon Qi, PhD, is a Professor of Medical Physics in the
Department of Radiation Oncology at the University of California Los Angeles (UCLA). She is an afliated faculty member of UCLAs CAMPEP-accredited Physics and Biology in Medicine Interdisciplinary Graduate Program. Dr. Qi is board­certied in Therapeutic Radiologic Physics by the American Board of Radiology and is a Fellow of the American Association of Physicists in Medicine (AAPM).
Dr. Qi earned her bachelors degree in physics and her PhD degree in Experimental Particle Physics from the Institute of High Energy Physics, Chinese Academy of Sciences in Beijing, China. She pursued her doctoral research as a scientist at Fermi National Accelerator Laboratory (Fermilab) in Batavia, Illinois, before completing a postdoctoral fellowship in Medical Physics at the Medical College of Wisconsin. She served as a faculty member in the Department of Radiation Oncology at the University of Colorado Denver prior to joining UCLA.
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Artificial Intelligence in Adaptive Radiation Therapy
Dr. Qi has served as both principal investigator and co-investigator on various research projects and clinical trials. She has published more than 130 peer-reviewed journal articles, over 220 peer reviewed abstracts, and 7 book chapters. Her research focuses on image-guided radiation therapy and adaptive radiation therapy, outcome modeling and response prediction, big data analytics, and the application of AI in radiotherapy oncology.
As an internationally recognized expert in AI for radiation therapy, Dr. Qi contributes actively to multiple AI-focused committees, working groups, and task groups with the AAPM. Her roles include serving on the Machine Intelligence Subcommittee (MIS) and the Therapy Physics Committee (TPC), Chairing Task Group 384 on the clinical implementation of automated segmentation for adaptive radiation therapy, and acting as Vice Chair of the Working Group on Generative Articial Intelligence. Beyond AAPM, she also contributes to broader national initiatives through the American Society for Radiation Oncology (ASTRO) and NRG Oncology.
Beyond her research and committee service, Dr. Qi actively contributes to scientic publishing, serving as Deputy Editor and Associate Editor for the Journal of Medical Physics, and holding editorial and peer review roles for other journals in radiation therapy.
xxiv

List of contributors

Brian Anderson
University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
Parsa Bagherzadeh
McGill University, 3755 Ch de la Côte Ste-Catherine Montréal, Québec, H3T
1E2, Canada
James M Balter
University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, USA
Kristy Brock
The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT
14.6048, Unit 1902, Houston, TX 77030, USA
Jing Cai
The Hong Kong Polytechnic University, Y921, Block Y, The Hong Kong
Polytechnic University, No 11 Yuk Choi Road, Hung Hom, Kowloon, Hong
Kong
Carlos Eduardo Cardenas
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Maria Chan
Memorial Sloan Kettering Cancer Center, 136 Mountainview Blvd, Basking
Ridge, NJ 07920, USA
Xinru Chen
The University of Texas MD Anderson Cancer Center, 1400 Pressler Street,
Houston, TX 77030, USA
Laurence Court
The University of Texas MD Anderson Cancer Center, 1515 Holcombe
Boulevard, Houston, Texas 77030, USA
Sunan Cui
University of Washington, 1959 NE Pacic Street Box Number 356043, Seattle,
WA 98195, USA
Xianjin Dai
Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
Denis Dudas
Czech Technical University in Prague, Břehová 78/7, 115 19 Prague, Czech
Republic
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Artificial Intelligence in Adaptive Radiation Therapy
Issam El Naqa
H Lee Moftt Cancer Center and Research Institute, 12902 Magnolia Drive,
Tampa, FL 33612, USA
Shirin Abbasinejad Enger
McGill University, 3755 Ch de la Côte Ste-Catherine Montréal, Québec, H3T
1E2, Canada
Andrew Fanning
University of Nebraska Medical Center, 986861 Nebraska Medical Center,
Omaha, NE 68198-6861, USA
Jie Fu
University of Washington, 1959 NE Pacic Street Box Number 356043, Seattle,
WA 98195, USA
Yu Gao
Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA, USA
Huaizhi Geng
University of Pennsylvania, 3400 Civic Center Boulevard, TRC-2 West,
Philadelphia, PA 19104, USA
Andrew Godley
University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas,
TX 75235, USA
Bin Han
Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA, USA
Joseph Harms
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Elizabeth Huynh
London Health Sciences Centre, 800 Commissioners Road East, London, ON,
N6A 5W9, Canada
Megan Hyun
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY
10065, USA
Yi Lao
City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA
91010, USA
Michael Vincent Lauria
University of California, Los Angeles, 200 Medical Plaza Driveway Suite B265,
Los Angeles, CA 90095, USA
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Artificial Intelligence in Adaptive Radiation Therapy
Sang Ho Lee
University of Pennsylvania, 3400 Civic Center Boulevard, TRC-2 West,
Philadelphia, PA 19104, USA
Sang Kyu Lee
Memorial Sloan Kettering Cancer Center, 480 Red Hill Road, Middletown, NJ
07748, USA
Mu-Han Li
University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas,
TX 75235, USA
Lianli Liu
Stanford University, 875 Blake Wilbur Drive, Palo Alto, CA, USA
Kelly Nealon
Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street,
Boston, MA 02114, USA
Jack Neylon
University of California, Los Angeles, 200 Medical Plaza Driveway, Suite B265,
Los Angeles, CA 90095, USA
Oscar Pastor-Serrano
Stanford University, 3145 Porter Drive, Wing A, Palo Alto CA 94304, USA
Joel Anthony Pogue
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Richard Allen Popple
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Jennifer Pursley
Mayo Clinic, Rochester, 200 1st Street SW, Rochester, MN 55905, USA
X. Sharon Qi
University of California, Los Angeles, 200 Medical Plaza Driveway, Suite B265,
Los Angeles, CA 90095, USA
Laya Raee Sevyeri
Medical Physics Unit, Department of Oncology, McGill University, Montreal,
Canada
Gregory Sharp
Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street,
Boston, MA 02114, USA
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Artificial Intelligence in Adaptive Radiation Therapy
Chenyang Shen
University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas,
TX 75235, USA
Lauren Smith
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY
10065, USA
Dennis Nichols Stanley
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Xinzhi Teng
The Hong Kong Polytechnic University, Y921, Block Y, The Hong Kong
Polytechnic University, No.11 Yuk Choi Road, Hung Hom, Kowloon, Hong
Kong
Ivan Vazquez
The University of Texas MD Anderson Cancer Center, 1840 Old Spanish Trl,
Houston, TX 77054, USA
Justin Visak
University of Texas Southwestern Medical Center, 2280 Inwood Rd, Dallas,
TX 75235, USA
Natalie Nicole Viscariello
University of Alabama at Birmingham, 1700 6th Avenue Street, Birmingham, AL
35233, USA
Tonghe Wang
Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York,
NY 10065, USA
Yi Wang
Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street,
Boston, MA 02114, USA
Brian Winey
Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street,
Cox 3, Boston, MA 02114, USA
Jinzhong Yang
The University of Texas MD Anderson Cancer Center, 1400 Pressler Street,
Houston, TX 77030, USA
Ming Yang
The University of Texas MD Anderson Cancer Center, 1840 Old Spanish Trl,
Houston, TX 77054, USA
Xiaofeng Yang
Emory University, 1365 Clifton Road NE, Building C, Atlanta, GA 30322, USA
xxviii
Artificial Intelligence in Adaptive Radiation Therapy
Cenji Yu
Mayo Clinic, Rochester, 200 First Street SW, Rochester, MN 55905, USA
Ying Xiao
University of Pennsylvania, 3400 Civic Center Boulevard, TRC-2 West,
Philadelphia, PA 19104, USA
Lei Xing
Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
Jiang Zhang
The Hong Kong Polytechnic University, Y921, Block Y, The Hong Kong
Polytechnic University, No 11 Yuk Choi Road, Hung Hom, Kowloon, Hong
Kong
Xinyu Zhang
The Hong Kong Polytechnic University, Y921, Block Y, The Hong Kong
Polytechnic University, No 11 Yuk Choi Road, Hung Hom, Kowloon, Hong
Kong
Yuanpeng Zhang
The Hong Kong Polytechnic University, Y921, Block Y, The Hong Kong
Polytechnic University, No 11 Yuk Choi Road, Hung Hom, Kowloon, Hong
Kong
Yao Zhao
The University of Texas MD Anderson Cancer Center, 1400 Pressler Street,
Houston, TX 77030, USA
Dandan Zheng
University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
Yujing Zou
McGill University, 3755 Ch de la Côte Ste-Catherine Montréal, Québec, H3T
1E2, Canada
xxix