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Barten DLJ, Pieters BR, Bouter A, van der Meer MC, Maree SC, Hinnen KA, Westerveld H, Bosman PAN, Alderliesten T, van Wieringen N, Bel A. Towards artificial intelligence-based automated treatment planning in clinical practice: A prospective study of the first clinical experiences in high-dose-rate prostate brachytherapy. Brachytherapy 2023; 22:279-289. [PMID: 36635201 DOI: 10.1016/j.brachy.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE This prospective study evaluates our first clinical experiences with the novel ``BRachytherapy via artificial Intelligent GOMEA-Heuristic based Treatment planning'' (BRIGHT) applied to high-dose-rate prostate brachytherapy. METHODS AND MATERIALS Between March 2020 and October 2021, 14 prostate cancer patients were treated in our center with a 15Gy HDR-brachytherapy boost. BRIGHT was used for bi-objective treatment plan optimization and selection of the most desirable plans from a coverage-sparing trade-off curve. Selected BRIGHT plans were imported into the commercial treatment planning system Oncentra Brachy . In Oncentra Brachy a dose distribution comparison was performed for clinical plan choice, followed by manual fine-tuning of the preferred BRIGHT plan when deemed necessary. The reasons for plan selection, clinical plan choice, and fine-tuning, as well as process speed were monitored. For each patient, the dose-volume parameters of the (fine-tuned) clinical plan were evaluated. RESULTS In all patients, BRIGHT provided solutions satisfying all protocol values for coverage and sparing. In four patients not all dose-volume criteria of the clinical plan were satisfied after manual fine-tuning. Detailed information on tumour coverage, dose-distribution, dwell time pattern, and insight provided by the patient-specific trade-off curve, were used for clinical plan choice. Median time spent on treatment planning was 42 min, consisting of 16 min plan optimization and selection, and 26 min undesirable process steps. CONCLUSIONS BRIGHT is implemented in our clinic and provides automated prostate high-dose-rate brachytherapy planning with trade-off based plan selection. Based on our experience, additional optimization aims need to be implemented to further improve direct clinical applicability of treatment plans and process efficiency.
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Affiliation(s)
- Danique L J Barten
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Anton Bouter
- Centrum Wiskunde & Informatica (CWI), Life Sciences and Health, Amsterdam, The Netherlands
| | - Marjolein C van der Meer
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Stef C Maree
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Karel A Hinnen
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Henrike Westerveld
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Peter A N Bosman
- Centrum Wiskunde & Informatica (CWI), Life Sciences and Health, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Niek van Wieringen
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Shavazipour B, Afsar B, Multanen J, Miettinen K, Kujala UM. Interactive multiobjective optimization for finding the most preferred exercise therapy modality in knee osteoarthritis. Ann Med 2022; 54:181-194. [PMID: 35023426 PMCID: PMC8759734 DOI: 10.1080/07853890.2021.2024876] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There are no explicit guidelines or tools available to support clinicians in selecting exercise therapy modalities according to the characteristics of individual patients despite the apparent need. OBJECTIVE This study develops a methodology based on a novel multiobjective optimization model and examines its feasibility as a decision support tool to support healthcare professionals in comparing different modalities and identifying the most preferred one based on a patient's needs. METHODS Thirty-one exercise therapy modalities were considered from 21 randomized controlled trials. A novel interactive multiobjective optimization model was designed to characterize the efficacy of an exercise therapy modality based on five objectives: minimizing cost, maximizing pain reduction, maximizing disability improvement, minimizing the number of supervised sessions, and minimizing the length of the treatment period. An interactive model incorporates clinicians' preferences in finding the most preferred exercise therapy modality for each need. Multiobjective optimization methods are mathematical algorithms designed to identify the optimal balance between multiple conflicting objectives among available solutions/alternatives. They explicitly evaluate the conflicting objectives and support decision-makers in identifying the best balance. An experienced research-oriented physiotherapist was involved as a decision-maker in the interactive solution process testing the proposed decision support tool. RESULTS The proposed methodology design and interactive process of the tool, including preference information, graphs, and exercise suggestions following the preferences, can help clinicians to find the most preferred exercise therapy modality based on a patient's needs and health status; paving the way to individualize recommendations. CONCLUSIONS We examined the feasibility of our decision support tool using an interactive multiobjective optimization method designed to help clinicians balance between conflicting objectives to find the most preferred exercise therapy modality for patients with knee osteoarthritis. The proposed methodology is generic enough to be applied in any field of medical and healthcare settings, where several alternative treatment options exist.KEY MESSAGESWe demonstrate the potential of applying Interactive multiobjective optimization methods in a decision support tool to help clinicians compare different exercise therapy modalities and identify the most preferred one based on a patient's needs.The usability of the proposed decision support tool is tested and demonstrated in prescribing exercise therapy modalities to treat knee osteoarthritis patients.
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Affiliation(s)
| | - Bekir Afsar
- Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Juhani Multanen
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland.,Department of Physical Medicine and Rehabilitation, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Kaisa Miettinen
- Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
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Ma M, Kidd E, Fahimian BP, Han B, Niedermayr TR, Hristov D, Xing L, Yang Y. Dose Prediction for Cervical Cancer Brachytherapy Using 3-D Deep Convolutional Neural Network. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2022. [DOI: 10.1109/trpms.2021.3098507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Morén B, Larsson T, Tedgren ÅC. Optimization in treatment planning of high dose-rate brachytherapy - Review and analysis of mathematical models. Med Phys 2021; 48:2057-2082. [PMID: 33576027 DOI: 10.1002/mp.14762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment planning in high dose-rate brachytherapy has traditionally been conducted with manual forward planning, but inverse planning is today increasingly used in clinical practice. There is a large variety of proposed optimization models and algorithms to model and solve the treatment planning problem. Two major parts of inverse treatment planning for which mathematical optimization can be used are the decisions about catheter placement and dwell time distributions. Both these problems as well as integrated approaches are included in this review. The proposed models include linear penalty models, dose-volume models, mean-tail dose models, quadratic penalty models, radiobiological models, and multiobjective models. The aim of this survey is twofold: (i) to give a broad overview over mathematical optimization models used for treatment planning of brachytherapy and (ii) to provide mathematical analyses and comparisons between models. New technologies for brachytherapy treatments and methods for treatment planning are also discussed. Of particular interest for future research is a thorough comparison between optimization models and algorithms on the same dataset, and clinical validation of proposed optimization approaches with respect to patient outcome.
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Affiliation(s)
- Björn Morén
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Torbjörn Larsson
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
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Wu VW, Epelman MA, Pasupathy KS, Sir MY, Deufel CL. A new optimization algorithm for HDR brachytherapy that improves DVH-based planning: Truncated Conditional Value-at-Risk (TCVaR). Biomed Phys Eng Express 2020; 6. [PMID: 35102005 DOI: 10.1088/2057-1976/abb4bc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/02/2020] [Indexed: 11/12/2022]
Abstract
Purpose:To introduce a new optimization algorithm that improves DVH results and is designed for the type of heterogeneous dose distributions that occur in brachytherapy.Methods:The new optimization algorithm is based on a prior mathematical approach that uses mean doses of the DVH metric tails. The prior mean dose approach is referred to as conditional value-at-risk (CVaR), and unfortunately produces noticeably worse DVH metric results than gradient-based approaches. We have improved upon the CVaR approach, using the so-called Truncated CVaR (TCVaR), by excluding the hottest or coldest voxels in the structure from the calculations of the mean dose of the tail. Our approach applies an iterative sequence of convex approximations to improve the selection of the excluded voxels. Data Envelopment Analysis was used to quantify the sensitivity of TCVaR results to parameter choice and to compare the quality of a library of 256 TCVaR plans created for each of prostate, breast, and cervix treatment sites with commercially-generated plans.Results:In terms of traditional DVH metrics, TCVaR outperformed CVaR and the improvements increased monotonically as more iterations were used to identify and exclude the hottest/coldest voxels from the optimization problem. TCVaR also outperformed the Eclipse-Brachyvision TPS, with an improvement in PTVD95% (for equivalent organ-at-risk doses) of up to 5% (prostate), 3% (breast), and 1% (cervix).Conclusions:A novel optimization algorithm for HDR treatment planning produced plans with superior DVH metrics compared with a prior convex optimization algorithm as well as Eclipse-Brachyvision. The algorithm is computationally efficient and has potential applications as a primary optimization algorithm or quality assurance for existing optimization approaches.
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Affiliation(s)
- Victor W Wu
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America.,Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Marina A Epelman
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Kalyan S Pasupathy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States of America.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Mustafa Y Sir
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States of America.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Christopher L Deufel
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, United States of America
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Bélanger C, Poulin É, Cui S, Vigneault É, Martin AG, Foster W, Després P, Cunha JAM, Beaulieu L. Evaluating the impact of real-time multicriteria optimizers integrated with interactive plan navigation tools for HDR brachytherapy. Brachytherapy 2020; 19:607-617. [PMID: 32713779 DOI: 10.1016/j.brachy.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/05/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Currently in high-dose-rate (HDR) brachytherapy planning, manual fine-tuning of an objective function is a common practice. Furthermore, automated planning approaches such as multicriteria optimization (MCO) are still limited to the automatic generation of a single treatment plan. This study aims to quantify planning efficiency gains when using a graphics processing unit-based MCO (gMCO) algorithm combined with a novel graphical user interface (gMCO-GUI) that integrates efficient automated and interactive plan navigation tools. METHODS AND MATERIALS The gMCO algorithm was used to generate 1000 Pareto optimal plans per case for 379 prostate cases. gMCO-GUI was developed to allow plan navigation through all plans. gMCO-GUI integrates interactive parameter selection tools directly with the optimization algorithm to allow plan navigation. The quality of each plan was evaluated based on the Radiation Treatment Oncology Group 0924 protocol and a more stringent institutional protocol (INSTp). gMCO-GUI allows real-time time display of the dose-volume histogram indices, the dose-volume histogram curves, and the isodose lines during the plan navigation. RESULTS Over the 379 cases, the fraction of Radiation Treatment Oncology Group 0924 protocol valid plans with target coverage greater than 95% was 90.8%, compared with 66.0% for clinical plans. The fraction of INSTp valid plans with target coverage greater than 95% was 81.8%, compared with 62.3% for clinical plans. The average time to compute 1000 deliverable plans with gMCO was 12.5 s, including the full computation of the 3D dose distributions. CONCLUSIONS Combining the gMCO algorithm with automated and interactive plan navigation tools resulted in simultaneous gains in both plan quality and planning efficiency.
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Affiliation(s)
- Cédric Bélanger
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Éric Poulin
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Songye Cui
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Éric Vigneault
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - André-Guy Martin
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - William Foster
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Philippe Després
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - J Adam M Cunha
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Luc Beaulieu
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada.
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Deufel CL, Epelman MA, Pasupathy KS, Sir MY, Wu VW, Herman MG. PNaV: A tool for generating a high-dose-rate brachytherapy treatment plan by navigating the Pareto surface guided by the visualization of multidimensional trade-offs. Brachytherapy 2020; 19:518-531. [DOI: 10.1016/j.brachy.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/16/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
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Cunha JAM, Flynn R, Bélanger C, Callaghan C, Kim Y, Jia X, Chen Z, Beaulieu L. Brachytherapy Future Directions. Semin Radiat Oncol 2020; 30:94-106. [DOI: 10.1016/j.semradonc.2019.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Breedveld S, Bennan ABA, Aluwini S, Schaart DR, Kolkman-Deurloo IKK, Heijmen BJM. Fast automated multi-criteria planning for HDR brachytherapy explored for prostate cancer. ACTA ACUST UNITED AC 2019; 64:205002. [DOI: 10.1088/1361-6560/ab44ff] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Evaluation of bi-objective treatment planning for high-dose-rate prostate brachytherapy—A retrospective observer study. Brachytherapy 2019; 18:396-403. [DOI: 10.1016/j.brachy.2018.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/08/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
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Dinkla AM, van der Laarse R, Kaljouw E, Pieters BR, Koedooder K, van Wieringen N, Bel A. A comparison of inverse optimization algorithms for HDR/PDR prostate brachytherapy treatment planning. Brachytherapy 2015; 14:279-88. [DOI: 10.1016/j.brachy.2014.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
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Dinkla AM, van der Laarse R, Koedooder K, Petra Kok H, van Wieringen N, Pieters BR, Bel A. Novel tools for stepping source brachytherapy treatment planning: Enhanced geometrical optimization and interactive inverse planning. Med Phys 2014; 42:348-53. [DOI: 10.1118/1.4904020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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De Boeck L, Beliën J, Egyed W. Dose optimization in high-dose-rate brachytherapy: A literature review of quantitative models from 1990 to 2010. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.orhc.2013.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holm Å, Larsson T, Tedgren ÅC. A linear programming model for optimizing HDR brachytherapy dose distributions with respect to mean dose in the DVH-tail. Med Phys 2013; 40:081705. [DOI: 10.1118/1.4812677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Breedveld S, Storchi PRM, Voet PWJ, Heijmen BJM. iCycle: Integrated, multicriterial beam angle, and profile optimization for generation of coplanar and noncoplanar IMRT plans. Med Phys 2012; 39:951-63. [PMID: 22320804 DOI: 10.1118/1.3676689] [Citation(s) in RCA: 222] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To introduce iCycle, a novel algorithm for integrated, multicriterial optimization of beam angles, and intensity modulated radiotherapy (IMRT) profiles. METHODS A multicriterial plan optimization with iCycle is based on a prescription called wish-list, containing hard constraints and objectives with ascribed priorities. Priorities are ordinal parameters used for relative importance ranking of the objectives. The higher an objective priority is, the higher the probability that the corresponding objective will be met. Beam directions are selected from an input set of candidate directions. Input sets can be restricted, e.g., to allow only generation of coplanar plans, or to avoid collisions between patient/couch and the gantry in a noncoplanar setup. Obtaining clinically feasible calculation times was an important design criterium for development of iCycle. This could be realized by sequentially adding beams to the treatment plan in an iterative procedure. Each iteration loop starts with selection of the optimal direction to be added. Then, a Pareto-optimal IMRT plan is generated for the (fixed) beam setup that includes all so far selected directions, using a previously published algorithm for multicriterial optimization of fluence profiles for a fixed beam arrangement Breedveld et al. [Phys. Med. Biol. 54, 7199-7209 (2009)]. To select the next direction, each not yet selected candidate direction is temporarily added to the plan and an optimization problem, derived from the Lagrangian obtained from the just performed optimization for establishing the Pareto-optimal plan, is solved. For each patient, a single one-beam, two-beam, three-beam, etc. Pareto-optimal plan is generated until addition of beams does no longer result in significant plan quality improvement. Plan generation with iCycle is fully automated. RESULTS Performance and characteristics of iCycle are demonstrated by generating plans for a maxillary sinus case, a cervical cancer patient, and a liver patient treated with SBRT. Plans generated with beam angle optimization did better meet the clinical goals than equiangular or manually selected configurations. For the maxillary sinus and liver cases, significant improvements for noncoplanar setups were seen. The cervix case showed that also in IMRT with coplanar setups, beam angle optimization with iCycle may improve plan quality. Computation times for coplanar plans were around 1-2 h and for noncoplanar plans 4-7 h, depending on the number of beams and the complexity of the site. CONCLUSIONS Integrated beam angle and profile optimization with iCycle may result in significant improvements in treatment plan quality. Due to automation, the plan generation workload is minimal. Clinical application has started.
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Affiliation(s)
- Sebastiaan Breedveld
- Department of Radiation Oncology, Erasmus MC Rotterdam, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
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