Purpose To develop a knowledge‐based automated planning pipeline that generates treatment plans without feature engineering, using deep neural network architectures for predicting three‐dimensional (3D) dose. Methods Our knowledge‐based automated planning (KBAP) pipeline consisted of a knowledge‐based planning (KBP) method that predicts dose for a contoured computed tomography (CT) image followed by two optimization models that learn objective function weights and generate fluence‐based plans, respectively. We developed a novel generative adversarial network (GAN)‐based KBP approach, a 3D GAN model, which predicts dose for the full 3D CT image at once and accounts for correlations between adjacent CT slices. Baseline comparisons were made against two state‐of‐the‐art deep learning–based KBP methods from the literature. We also developed an additional benchmark, a two‐dimensional (2D) GAN model which predicts dose to each axial slice independently. For all models, we investigated the impact of multiplicatively scaling the predictions before optimization, such that the predicted dose distributions achieved all target clinical criteria. Each KBP model was trained on 130 previously delivered oropharyngeal treatment plans. Performance was tested on 87 out‐of‐sample previously delivered treatment plans. All KBAP plans were evaluated using clinical planning criteria and compared to their corresponding clinical plans. KBP prediction quality was assessed using dose‐volume histogram (DVH) differences from the corresponding clinical plans. Results The best performing KBAP plans were generated using predictions from the 3D GAN model that were multiplicatively scaled. These plans satisfied 77% of all clinical criteria, compared to the clinical plans, which satisfied 67% of all criteria. In general, multiplicatively scaling predictions prior to optimization increased the fraction of clinical criteria satisfaction by 11% relative to the plans generated with nonscaled predictions. Additionally, these KBAP plans satisfied the same criteria as the clinical plans 84% and 8% more frequently as compared to the two benchmark methods, respectively. Conclusions We developed the first knowledge‐based automated planning framework using a 3D generative adversarial network for prediction. Our results, based on 217 oropharyngeal cancer treatment plans, demonstrated superior performance in satisfying clinical criteria and generated more realistic plans as compared to the previous state‐of‐the‐art approaches.

Abstract-The column Hamming distance of a convolutional code determines the error correction capability when streaming over a class of packet erasure channels. We introduce a metric known as the column sum rank, that parallels column Hamming distance when streaming over a network with link failures. We prove rank analogues of several known column Hamming distance properties and introduce a new family of convolutional codes that maximize the column sum rank up to the code memory. Our construction involves finding a class of superregular matrices that preserve this property after multiplication with non-singular block diagonal matrices in the ground field.

To advance fair and consistent comparisons of dose prediction methods for knowledgebased planning (KBP) in radiation therapy research. Methods: We hosted OpenKBP, a 2020 AAPM Grand Challenge, and challenged participants to develop the best method for predicting the dose of contoured computed tomography (CT) images. The models were evaluated according to two separate scores: (a) dose score, which evaluates the full three-dimensional (3D) dose distributions, and (b) dose-volume histogram (DVH) score, which evaluates a set DVH metrics. We used these scores to quantify the quality of the models based on their out-of-sample predictions. To develop and test their models, participants were given the data of 340 patients who were treated for head-and-neck cancer with radiation therapy. The data were partitioned into training (n ¼ 200), validation (n ¼ 40), and testing (n ¼ 100) datasets. All participants performed training and validation with the corresponding datasets during the first (validation) phase of the Challenge. In the second (testing) phase, the participants used their model on the testing data to quantify the out-of-sample performance, which was hidden from participants and used to determine the final competition ranking. Participants also responded to a survey to summarize their models. Results: The Challenge attracted 195 participants from 28 countries, and 73 of those participants formed 44 teams in the validation phase, which received a total of 1750 submissions. The testing phase garnered submissions from 28 of those teams, which represents 28 unique prediction methods. On average, over the course of the validation phase, participants improved the dose and DVH scores of their models by a factor of 2.7 and 5.7, respectively. In the testing phase one model achieved the best dose score (2.429) and DVH score (1.478), which were both significantly better than the dose score (2.564) and the DVH score (1.529) that was achieved by the runner-up models. Lastly, many of the top performing teams reported that they used generalizable techniques (e.g., ensembles) to achieve higher performance than their competition. Conclusion: OpenKBP is the first competition for knowledge-based planning research. The Challenge helped launch the first platform that enables researchers to compare KBP prediction methods fairly and consistently using a large open-source dataset and standardized metrics. OpenKBP has also democratized KBP research by making it accessible to everyone, which should help accelerate the progress of KBP research. The OpenKBP datasets are available publicly to help benchmark future KBP research.