Seed implant brachytherapy (SIBT) is an effective cancer treatment modality; however, clinical planning often relies on manual adjustment of objective function weights, leading to inefficiencies and suboptimal results. This study proposes an adaptive weight optimization framework for SIBT planning, driven by large language models (LLMs). A locally deployed DeepSeek-R1 LLM is integrated with an automatic planning algorithm in an iterative loop. Starting with fixed weights, the LLM evaluates plan quality and recommends new weights in the next iteration. This process continues until convergence criteria are met, after which the LLM conducts a comprehensive evaluation to identify the optimal plan. A clinical knowledge base, constructed and queried via retrieval-augmented generation (RAG), enhances the model's domain-specific reasoning. The proposed method was validated on 23 patient cases, showing that the LLM-assisted approach produces plans that are comparable to or exceeding clinically approved and fixed-weight plans, in terms of dose homogeneity for the clinical target volume (CTV) and sparing of organs at risk (OARs). The study demonstrates the potential use of LLMs in SIBT planning automation.

High-dose-rate (HDR) brachytherapy plays a critical role in the treatment of locally advanced cervical cancer but remains highly dependent on manual treatment planning expertise. The objective of this study is to develop a fully automated HDR brachytherapy planning framework that integrates reinforcement learning (RL) and dose-based optimization to generate clinically acceptable treatment plans with improved consistency and efficiency. We propose a hierarchical two-stage autoplanning framework. In the first stage, a deep Q-network (DQN)-based RL agent iteratively selects treatment planning parameters (TPPs), which control the trade-offs between target coverage and organ-at-risk (OAR) sparing. The agent's state representation includes both dose-volume histogram (DVH) metrics and current TPP values, while its reward function incorporates clinical dose objectives and safety constraints, including D90, V150, V200 for targets, and D2cc for all relevant OARs (bladder, rectum, sigmoid, small bowel, and large bowel). In the second stage, a customized Adam-based optimizer computes the corresponding dwell time distribution for the selected TPPs using a clinically informed loss function. The framework was evaluated on a cohort of patients with complex applicator geometries. The proposed framework successfully learned clinically meaningful TPP adjustments across diverse patient anatomies. For the unseen test patients, the RL-based automated planning method achieved an average score of 93.89%, outperforming the clinical plans which averaged 91.86%. These findings are notable given that score improvements were achieved while maintaining full target coverage and reducing CTV hot spots in most cases.

Purpose: In high-dose-rate (HDR) prostate brachytherapy procedures, the pattern of needle placement solely relies on physician experience. We investigated the feasibility of using reinforcement learning (RL) to provide needle positions and dwell times based on patient anatomy during pre-planning stage. This approach would reduce procedure time and ensure consistent plan quality. Materials and Methods: We train a RL agent to adjust the position of one selected needle and all the dwell times on it to maximize a pre-defined reward function after observing the environment. After adjusting, the RL agent then moves on to the next needle, until all needles are adjusted. Multiple rounds are played by the agent until the maximum number of rounds is reached. Plan data from 11 prostate HDR boost patients (1 for training, and 10 for testing) treated in our clinic were included in this study. The dosimetric metrics and the number of used needles of RL plan were compared to those of the clinical results (ground truth). Results: On average, RL plans and clinical plans have very similar prostate coverage (Prostate V100) and Rectum D2cc (no statistical significance), while RL plans have less prostate hotspot (Prostate V150) and Urethra D20% plans with statistical significance. Moreover, RL plans use 2 less needles than clinical plan on average. Conclusion: We present the first study demonstrating the feasibility of using reinforcement learning to autonomously generate clinically practical HDR prostate brachytherapy plans. This RL-based method achieved equal or improved plan quality compared to conventional clinical approaches while requiring fewer needles. With minimal data requirements and strong generalizability, this approach has substantial potential to standardize brachytherapy planning, reduce clinical variability, and enhance patient outcomes.

Decentralized federated learning enables learning of data representations from multiple sources without compromising the privacy of the clients. In applications like medical image segmentation, where obtaining a large annotated dataset from a single source is a distressing problem, federated self-supervised learning can provide some solace. In this work, we push the limits further by exploring a federated self-supervised one-shot segmentation task representing a more data-scarce scenario. We adopt a pre-existing self-supervised few-shot segmentation framework CoWPro and adapt it to the federated learning scenario. To the best of our knowledge, this work is the first to attempt a self-supervised few-shot segmentation task in the federated learning domain. Moreover, we consider the clients to be constituted of data from different modalities and imaging techniques like MR or CT, which makes the problem even harder. Additionally, we reinforce and improve the baseline CoWPro method using a fused dice loss which shows considerable improvement in performance over the baseline CoWPro. Finally, we evaluate this novel framework on a completely unseen held-out part of the local client dataset. We observe that the proposed framework can achieve performance at par or better than the FedAvg version of the CoWPro framework on the held-out validation dataset.

Countless science and engineering applications in multi-objective optimization (MOO) necessitate that decision-makers (DMs) select a Pareto-optimal solution which aligns with their preferences. Evaluating individual solutions is often expensive, necessitating cost-sensitive optimization techniques. Due to competing objectives, the space of trade-offs is also expansive -- thus, examining the full Pareto frontier may prove overwhelming to a DM. Such real-world settings generally have loosely-defined and context-specific desirable regions for each objective function that can aid in constraining the search over the Pareto frontier. We introduce a novel conceptual framework that operationalizes these priors using soft-hard functions, SHFs, which allow for the DM to intuitively impose soft and hard bounds on each objective -- which has been lacking in previous MOO frameworks. Leveraging a novel minimax formulation for Pareto frontier sampling, we propose a two-step process for obtaining a compact set of Pareto-optimal points which respect the user-defined soft and hard bounds: (1) densely sample the Pareto frontier using Bayesian optimization, and (2) sparsify the selected set to surface to the user, using robust submodular function optimization. We prove that (2) obtains the optimal compact Pareto-optimal set of points from (1). We further show that many practical problems fit within the SHF framework and provide extensive empirical validation on diverse domains, including brachytherapy, engineering design, and large language model personalization. Specifically, for brachytherapy, our approach returns a compact set of points with over 3% greater SHF-defined utility than the next best approach. Among the other diverse experiments, our approach consistently leads in utility, allowing the DM to reach >99% of their maximum possible desired utility within validation of 5 points.

Despite significant advancements, large language models (LLMs) still struggle with providing accurate answers when lacking domain-specific or up-to-date knowledge. Retrieval-Augmented Generation (RAG) addresses this limitation by incorporating external knowledge bases, but it also introduces new attack surfaces. In this paper, we investigate data extraction attacks targeting the knowledge databases of RAG systems. We demonstrate that previous attacks on RAG largely depend on the instruction-following capabilities of LLMs, and that simple fine-tuning can reduce the success rate of such attacks to nearly zero. This makes these attacks impractical since fine-tuning is a common practice when deploying LLMs in specific domains. To further reveal the vulnerability, we propose to backdoor RAG, where a small portion of poisoned data is injected during the fine-tuning phase to create a backdoor within the LLM. When this compromised LLM is integrated into a RAG system, attackers can exploit specific triggers in prompts to manipulate the LLM to leak documents from the retrieval database. By carefully designing the poisoned data, we achieve both verbatim and paraphrased document extraction. We show that with only 3\% poisoned data, our method achieves an average success rate of 79.7\% in verbatim extraction on Llama2-7B, with a ROUGE-L score of 64.21, and a 68.6\% average success rate in paraphrased extraction, with an average ROUGE score of 52.6 across four datasets. These results underscore the privacy risks associated with the supply chain when deploying RAG systems.

Generating physician letters is a time-consuming task in daily clinical practice. This study investigates local fine-tuning of large language models (LLMs), specifically LLaMA models, for physician letter generation in a privacy-preserving manner within the field of radiation oncology. Our findings demonstrate that base LLaMA models, without fine-tuning, are inadequate for effectively generating physician letters. The QLoRA algorithm provides an efficient method for local intra-institutional fine-tuning of LLMs with limited computational resources (i.e., a single 48 GB GPU workstation within the hospital). The fine-tuned LLM successfully learns radiation oncology-specific information and generates physician letters in an institution-specific style. ROUGE scores of the generated summary reports highlight the superiority of the 8B LLaMA-3 model over the 13B LLaMA-2 model. Further multidimensional physician evaluations of 10 cases reveal that, although the fine-tuned LLaMA-3 model has limited capacity to generate content beyond the provided input data, it successfully generates salutations, diagnoses and treatment histories, recommendations for further treatment, and planned schedules. Overall, clinical benefit was rated highly by the clinical experts (average score of 3.44 on a 4-point scale). With careful physician review and correction, automated LLM-based physician letter generation has significant practical value.

Deep learning advanced to one of the most important technologies in almost all medical fields. Especially in areas, related to medical imaging it plays a big role. However, in interventional radiotherapy (brachytherapy) deep learning is still in an early phase. In this review, first, we investigated and scrutinised the role of deep learning in all processes of interventional radiotherapy and directly related fields. Additionally we summarised the most recent developments. To reproduce results of deep learning algorithms both source code and training data must be available. Therefore, a second focus of this work was on the analysis of the availability of open source, open data and open models. In our analysis, we were able to show that deep learning plays already a major role in some areas of interventional radiotherapy, but is still hardly presented in others. Nevertheless, its impact is increasing with the years, partly self-propelled but also influenced by closely related fields. Open source, data and models are growing in number but are still scarce and unevenly distributed among different research groups. The reluctance in publishing code, data and models limits reproducibility and restricts evaluation to mono-institutional datasets. Summarised, deep learning will change positively the workflow of interventional radiotherapy but there is room for improvement when it comes to reproducible results and standardised evaluation methods.

New artificial intelligence (AI) capabilities may make it possible to improve the effectiveness of brachytherapy for men with prostate cancer (PCa) by almost instantly generating dosage plans, according to investigators. In a typical high-dose rate (HDR) brachytherapy procedure for PCa, needle applicators are first inserted by the physician to the tumor target. A planner then develops a treatment plan manually. During this time the patient carries the needles, waiting for the planning to finish. With the current standard of care, it takes up to an hour or more to generate a high-quality plan.