{"doi":"10.1101/2025.11.23.25340237","title":"Radiation-specific Automated Dosimetric dental, Mandible, and maxilla Annotation for Predicting Periodontal Problems (RADMAP): A semi-automated tool for dosimetric oral risk communication and osteoradionecrosis assessment","abstract":"Purpose/Objectives: Osteoradionecrosis of the jaw (ORN) is a severe complication of head and neck cancer (HNC) radiotherapy (RT), significantly impacting patient quality of life. Current dose assessment relies on whole-mandible dosimetry, limiting personalized, tooth-specific region risk evaluation. The lack of standardized methods to document and analyze dose distributions to tooth-bearing regions further hampers dental and maxillofacial decision-making. This study develops and evaluates RADMAP, a (semi-)automated tool for segmenting tooth-based jaw regions, enabling patient- and tooth-specific radiation dose mapping to improve dental dose reporting and ORN risk assessment. Methods and Materials: A total of 736 tooth locations from 23 HNC patients treated with definitive RT were analyzed, including 11 who developed ORN. The RADMAP tool applies an angular ray-based algorithm to automatically segment the mandible and maxilla into 32 tooth-specific jaw regions, with optional manual refinement (semi-automated), outputting radiation dose mapping in both tabular and odontogram formats. Mean dose values from manually contoured tooth roots were compared with RADMAP-segmented alveolar regions (fully and semi-automated). Interobserver agreement among six users was evaluated. Whole-mandible, manual tooth, and tooth-based jaw segment (alveolar and basal) doses were compared between regions with and without ORN development. Results: = 0.98, p<0.0001), demonstrating accurate dose estimation. Interobserver agreement showed 95% limits of ±2.9 Gy for mandibular alveolar segments, confirming reproducibility. Tooth-based jaw segments showed a significant differentiation in radiation dose for the ORN-positive versus ORN-negative sites (difference in mean dose (DIM): 12.4 ±3.7 Gy, p=0.0008), which was not seen when considering the whole-mandible dose (DIM=6.2 ±4.3 Gy, p=0.17), demonstrating RADMAP's promise for improved ORN risk assessment. Conclusion: RADMAP enables accurate, tooth-specific dose mapping of the mandible and maxilla, and potential improved ORN risk differentiation beyond whole-mandible dosimetry. Tooth-based dose reporting can personalize treatment, enhance multidisciplinary communication, and support prevention of radiation-related orodental sequelae.","journal":"medRxiv","year":2025,"id":559599,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":1,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9325,"is_data_producer":true,"deposit_databanks":{"figshare":["10.6084/m9.figshare.30465716"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1212508,"name":"Laia Humbert‐Vidan","orcid":"0000-0002-8005-6770","position":1,"is_corresponding":false},{"id":1162377,"name":"Erin Watson","orcid":"0000-0002-2096-7732","position":2,"is_corresponding":false},{"id":1325924,"name":"Ruth Aponte Wesson","orcid":"0000-0003-0233-9035","position":3,"is_corresponding":false},{"id":885534,"name":"Luisa E. Jacomina","orcid":"0000-0001-7553-9674","position":4,"is_corresponding":false},{"id":426705,"name":"Renjie He","orcid":"0000-0001-9166-6286","position":5,"is_corresponding":false},{"id":653657,"name":"Mohamed A. Naser","orcid":"0000-0003-1020-4966","position":6,"is_corresponding":false},{"id":299197,"name":"Dong Joo Rhee","orcid":"0000-0003-0486-1556","position":7,"is_corresponding":false},{"id":517405,"name":"He Wang","orcid":"0000-0002-4904-531X","position":8,"is_corresponding":false},{"id":351185,"name":"Stephen Y. Lai","orcid":"0000-0001-8301-7286","position":9,"is_corresponding":false},{"id":522272,"name":"Muhammad F. Walji","orcid":"0000-0001-5306-9683","position":10,"is_corresponding":false},{"id":480586,"name":"Max J. H. Witjes","orcid":"0000-0002-4135-3246","position":11,"is_corresponding":false},{"id":390503,"name":"Matthew S. Katz","orcid":"0000-0002-0239-9807","position":12,"is_corresponding":false},{"id":756014,"name":"Andrew Hope","orcid":"0000-0001-6793-2863","position":13,"is_corresponding":false},{"id":419800,"name":"Mark S. Chambers","orcid":"0000-0001-8901-6583","position":14,"is_corresponding":false},{"id":295555,"name":"Clifton D. Fuller","orcid":"0000-0002-5264-3994","position":15,"is_corresponding":false},{"id":346829,"name":"Amy C. Moreno","orcid":"0000-0001-6762-6807","position":16,"is_corresponding":false},{"id":103919,"name":"Lisanne V. van Dijk","orcid":"0000-0002-9515-5616","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:55:34.849815Z","pmid":"41358305","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}