Benchmarking GPT-5 in Radiation Oncology: Measurable Gains, but Persistent Need for Expert Oversight

Introduction: Large language models (LLM) have shown great potential in clinical decision support. GPT-5 is a novel LLM system that has been specifically marketed towards oncology use. Methods: Performance was assessed using two complementary benchmarks: (i) the ACR Radiation Oncology In-Training Examination (TXIT, 2021), comprising 300 multiple-choice items, and (ii) a curated set of 60 authentic radiation oncologic vignettes representing diverse disease sites and treatment indications. For the vignette evaluation, GPT-5 was instructed to generate concise therapeutic plans. Four board-certified radiation oncologists rated correctness, comprehensiveness, and hallucinations. Inter-rater reliability was quantified using Fleiss' \k{appa}. Results: On the TXIT benchmark, GPT-5 achieved a mean accuracy of 92.8%, outperforming GPT-4 (78.8%) and GPT-3.5 (62.1%). Domain-specific gains were most pronounced in Dose and Diagnosis. In the vignette evaluation, GPT-5's treatment recommendations were rated highly for correctness (mean 3.24/4, 95% CI: 3.11-3.38) and comprehensiveness (3.59/4, 95% CI: 3.49-3.69). Hallucinations were rare with no case reaching majority consensus for their presence. Inter-rater agreement was low (Fleiss' \k{appa} 0.083 for correctness), reflecting inherent variability in clinical judgment. Errors clustered in complex scenarios requiring precise trial knowledge or detailed clinical adaptation. Discussion: GPT-5 clearly outperformed prior model variants on the radiation oncology multiple-choice benchmark. Although GPT-5 exhibited favorable performance in generating real-world radiation oncology treatment recommendations, correctness ratings indicate room for further improvement. While hallucinations were infrequent, the presence of substantive errors underscores that GPT-5-generated recommendations require rigorous expert oversight before clinical implementation.

AnatoMix: Anatomy-aware Data Augmentation for Multi-organ Segmentation

Multi-organ segmentation in medical images is a widely researched task and can save much manual efforts of clinicians in daily routines. Automating the organ segmentation process using deep learning (DL) is a promising solution and state-of-the-art segmentation models are achieving promising accuracy. In this work, We proposed a novel data augmentation strategy for increasing the generalizibility of multi-organ segmentation datasets, namely AnatoMix. By object-level matching and manipulation, our method is able to generate new images with correct anatomy, i.e. organ segmentation mask, exponentially increasing the size of the segmentation dataset. Initial experiments have been done to investigate the segmentation performance influenced by our method on a public CT dataset. Our augmentation method can lead to mean dice of 76.1, compared with 74.8 of the baseline method.