# A recent evaluation on the performance of LLMs on radiation oncology physics using questions of randomly shuffled options

arXiv: https://arxiv.org/abs/2412.10622 · HTML: https://mlsanity.com/paper/2412.10622/

## Key facts

- Cited by 5 papers in the map (data through 14 Oct 2026).
- Builds on 18 of its 42 references that are in the map.
- First posted on arXiv 14 Dec 2024.

## Builds on (most cited first, 18 of 18)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Scaling Laws for Neural Language Models](https://mlsanity.com/paper/2001.08361/) (2020)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Gemini 1.5: Unlocking multimodal understanding across millions of tokens of context](https://mlsanity.com/paper/2403.05530/) (2024)
- [Don't Stop Pretraining: Adapt Language Models to Domains and Tasks](https://mlsanity.com/paper/2004.10964/) (2020)
- [The Rise and Potential of Large Language Model Based Agents: A Survey](https://mlsanity.com/paper/2309.07864/) (2023)
- [BiomedGPT: A Generalist Vision-Language Foundation Model for Diverse Biomedical Tasks](https://mlsanity.com/paper/2305.17100/) (2023)
- [Evaluating Large Language Models on a Highly-specialized Topic, Radiation Oncology Physics](https://mlsanity.com/paper/2304.01938/) (2023)
- [Artificial General Intelligence for Medical Imaging Analysis](https://mlsanity.com/paper/2306.05480/) (2023)
- [The Radiation Oncology NLP Database](https://mlsanity.com/paper/2401.10995/) (2024)

## Built on by (most cited first, 5 of 5)

- [RadOnc-GPT: An Autonomous LLM Agent for Real-Time Patient Outcomes Labeling at Scale](https://mlsanity.com/paper/2509.25540/) (2025)
- [Large Language Models for Bioinformatics](https://mlsanity.com/paper/2501.06271/) (2025)
- [Evaluating The Performance of Using Large Language Models to Automate Summarization of CT Simulation Orders in Radiation Oncology](https://mlsanity.com/paper/2501.16309/) (2025)
- [Benchmarking GPT-5 in Radiation Oncology: Measurable Gains, but Persistent Need for Expert Oversight](https://mlsanity.com/paper/2508.21777/) (2025)
- [An Automated Retrieval-Augmented Generation LLaMA-4 109B-based System for Evaluating Radiotherapy Treatment Plans](https://mlsanity.com/paper/2509.20707/) (2025)

## Abstract (arXiv)

Purpose: We present an updated study evaluating the performance of large language models (LLMs) in answering radiation oncology physics questions, focusing on the recently released models. Methods: A set of 100 multiple-choice radiation oncology physics questions, previously created by a well-experienced physicist, was used for this study. The answer options of the questions were randomly shuffled to create "new" exam sets. Five LLMs -- OpenAI o1-preview, GPT-4o, LLaMA 3.1 (405B), Gemini 1.5 Pro, and Claude 3.5 Sonnet -- with the versions released before September 30, 2024, were queried using these new exam sets. To evaluate their deductive reasoning ability, the correct answer options in the questions were replaced with "None of the above." Then, the explain-first and step-by-step instruction prompts were used to test if this strategy improved their reasoning ability. The performance of the LLMs was compared with the answers from medical physicists. Results: All models demonstrated expert-level performance on these questions, with o1-preview even surpassing medical physicists with a majority vote. When replacing the correct answer options with 'None of the above', all models exhibited a considerable decline in performance, suggesting room for improvement. The explain-first and step-by-step instruction prompts helped enhance the reasoning ability of the LLaMA 3.1 (405B), Gemini 1.5 Pro, and Claude 3.5 Sonnet models. Conclusion: These recently released LLMs demonstrated expert-level performance in answering radiation oncology physics questions, exhibiting great potential to assist in radiation oncology physics education and training.