Eduardo Antonio Cisternas Jimenez ^1* Fang-Fang Yin ^1,2,3*

• ¹ Medical Physics Graduate Program. Duke University, Durham, United States
• ² Department of Radiation Oncology, School of Medicine, Duke University, Durham, North Carolina, United States
• ³ Medical Physics Graduate Program, Duke Kunshan University, Kunshan, China

Intensity-Modulated Radiation Therapy requires the manual adjustment to numerous treatment plan parameters (TPPs) through a trial-and-error process to deliver precise radiation doses to the target while minimizing exposure to surrounding healthy tissues. The goal is to achieve a dose distribution that adheres to a prescribed plan tailored to each patient. Developing an automated approach to optimize patient-specific prescriptions is valuable in scenarios where trade-off selection is uncertain and varies among patients. This study presents a proof-of-concept artificial intelligence (AI) system based on an Adaptive Neuro-Fuzzy Inference System (ANFIS) to guide IMRT planning and achieve optimal, patient-specific prescriptions in alignment with a radiation oncologist's treatment objectives.We developed an in-house ANFIS-AI system utilizing Prescription Dose (PD) constraints to guide the optimization process toward achievable prescriptions. Mimicking human planning behavior, the AI system adjusts TPPs, represented as dose-volume constraints, to meet the prescribed dose goals. This process is informed by a Fuzzy Inference System (FIS) that incorporates prior knowledge from experienced planners, captured through ``if-then'' rules based on routine planning adjustments. The innovative aspect of our research lies in employing ANFIS’s adaptive network to fine-tune the FIS components (membership functions and rule strengths), thereby enhancing the accuracy of the system.Once calibrated, the AI system modifies TPPs for each patient, progressing through acceptable prescription levels, from restrictive to clinically allowable. The system evaluates dosimetric parameters and compares dose distributions, dose-volume histograms, and dosimetric statistics between the conventional FIS and ANFIS.Results demonstrate that ANFIS consistently met dosimetric goals, outperforming FIS with a 0.7\% improvement in mean dose conformity for the planning target volume (PTV) and a 28\% reduction in mean dose exposure for organs at risk (OARs) in a C-Shape phantom. In a mock prostate phantom, ANFIS reduced the mean dose by 17.4\% for the rectum and by 14.1\% for the bladder. These findings highlight ANFIS's potential for efficient, accurate IMRT planning and its integration into clinical workflows.