From LQ to AI-BED-Fx: A Unified Multi-Fraction Radiobiological and Machine-Learning Framework for Gamma Knife Radiosurgery Across Intracranial Pathologies

AI-BED-Fx provides the first unified, biologically explicit framework for modeling single- and multi-fraction Gamma Knife radiosurgery. The findings show that the predictive usefulness of BED is pathology-specific rather than universal, and that radiobiological dose provides additional predictive value only when repair kinetics and dose-response biology support it. By integrating mechanistic radiobiology with machine learning, AI-BED-Fx establishes the conceptual and computational foundations for biologically adaptive, AI-guided radiosurgery, and cross-pathology comparison of treatment response. This work uses large radiobiologically grounded synthetic cohorts for methodological validation; limited real-patient data are included only for exploratory consistency checks, and full clinical validation is planned.