Radiation Therapy (RT) plays a pivotal role in the treatment of cancer, offering the potential to effectively target and eliminate tumour cells while minimizing harm to surrounding healthy tissues. However, the success of RT heavily depends on meticulous treatment planning that ensures the optimal balance between delivering a sufficiently high dose to the tumour and sparing nearby critical organs. This critical process demands a multidisciplinary approach that combines medical expertise, advanced imaging techniques, and computational tools. Optimization techniques have emerged as indispensable tools in refining RT planning, enabling the precise adjustment of radiation beam arrangements and intensities to achieve treatment objectives while adhering to strict dose constraints. This study delves into the realm of constrained optimization within RT Treatment Planning, employing metaheuristic algorithms to enhance the efficacy of this process. The research focuses on the design and performance comparison of three prominent optimization techniques: Bat Search Optimization (BSO), Bacterial Foraging Algorithm (BFA), and Artificial Bee Colony (ABC). Through systematic evaluation, it is observed that BFA exhibits superior execution time and convergence capabilities in comparison to the other algorithms. This research underscores the crucial importance of RT planning and highlights the imperative need for optimization methodologies to achieve optimal treatment outcomes.
We apply the recently proposed superiorization methodology (SM) to the inverse planning problem in radiation therapy. The inverse planning problem is represented here as a constrained minimization problem of the total variation (TV) of the intensity vector over a large system of linear two-sided inequalities. The SM can be viewed conceptually as lying between feasibility-seeking for the constraints and full-fledged constrained minimization of the objective function subject to these constraints. It is based on the discovery that many feasibility-seeking algorithms (of the projection methods var…
We review the field of multi-criteria optimization for radiation therapy treatment planning. Special attention is given to the technique known as Pareto surface navigation, which allows physicians and treatment planners to interactively navigate through treatment planning options to get an understanding of the tradeoffs (dose to the target versus over-dosing of important nearby organs) involved in each patient's plan. We also describe goal programming and prioritized optimization, two other methods designed to handle multiple conflicting objectives. Issues related to nonconvexities, both in te…
In this paper we study a feasibility-seeking problem with percentage violation constraints. These are additional constraints, that are appended to an existing family of constraints, which single out certain subsets of the existing constraints and declare that up to a specified fraction of the number of constraints in each subset is allowed to be violated by up to a specified percentage of the existing bounds. Our motivation to investigate problems with percentage violation constraints comes from the field of radiation therapy treatment planning wherein the fully-discretized inverse planning pr…
A split feasibility formulation for the inverse problem of intensity-modulated radiation therapy (IMRT) treatment planning with dose-volume constraints (DVCs) included in the planning algorithm is presented. It involves a new type of sparsity constraint that enables the inclusion of a percentage-violation constraint in the model problem and its handling by continuous (as opposed to integer) methods. We propose an iterative algorithmic framework for solving such a problem by applying the feasibility-seeking CQ-algorithm of Byrne combined with the automatic relaxation method (ARM) that uses cycl…
Noncoplanar radiation therapy treatment planning has the potential to improve dosimetric quality as compared to traditional coplanar techniques. Likewise, automated treatment planning algorithms can reduce a planner's active treatment planning time and remove inter-planner variability. To address the limitations of traditional treatment planning, we have been developing a suite of algorithms called station parameter optimized radiation therapy (SPORT). Within the SPORT suite of algorithms, we propose a method called NC-POPS to produce noncoplanar (NC) plans using the fully automated Pareto Opt…
We propose a novel optimization model for volumetric modulated arc therapy (VMAT) planning that directly optimizes deliverable leaf trajectories in the treatment plan optimization problem, and eliminates the need for a separate arc-sequencing step. In this model, a 360-degree arc is divided into a given number of arc segments in which the leaves move unidirectionally. This facilitates an algorithm that determines the optimal piecewise linear leaf trajectories for each arc segment, which are deliverable in a given treatment time. Multi-leaf collimator (MLC) constraints, including maximum leaf s…
Objective: Radiation therapy treatment planning is a time-consuming process involving iterative adjustments of hyperparameters. To automate the treatment planning process, we propose a meta-optimization framework, called MetaPlanner (MP). Methods: Our MP algorithm automates planning by performing optimization of treatment planning hyperparameters. The algorithm uses a derivative-free method (i.e. parallel Nelder-Mead simplex search) to search for weight configurations that minimize a meta-scoring function. Meta-scoring is performed by constructing a tier list of the relevant considerations (e.…
Radiotherapy treatment planning currently requires many trail-and-error iterations between the planner and treatment planning system, as well as between the planner and physician for discussion/consultation. The physician's preferences for a particular patient cannot be easily quantified and precisely conveyed to the planner. In this study we present a real-time volumetric Pareto surface dose generation deep learning neural network that can be used after segmentation by the physician, adding a tangible and quantifiable end-point to portray to the planner. From 70 prostate patients, we first ge…
University of Toronto（多伦多大学）；Princess Margaret Cancer Centre（玛格丽特公主癌症中心）；York University（约克大学）
Knowledge-based planning (KBP) is an automated approach to radiation therapy treatment planning that involves predicting desirable treatment plans before they are then corrected to deliverable ones. We propose a generative adversarial network (GAN) approach for predicting desirable 3D dose distributions that eschews the previous paradigms of site-specific feature engineering and predicting low-dimensional representations of the plan. Experiments on a dataset of oropharyngeal cancer patients show that our approach significantly outperforms previous methods on several clinical satisfaction crite…
Radiation therapy treatment planning can be viewed as an iterative hyperparameter tuning process to balance conflicting clinical goals. In this work, we investigated the performance of modern Bayesian Optimization (BO) methods on automated treatment planning problems in high-dimensional settings. 20 locally advanced rectal cancer patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively selected as test cases. We implemented an automated treatment planning framework that adjusts dose objectives and weights simultaneously, and tested the performance of two BO metho…
Objective: We propose a semiautomatic pipeline for radiation therapy treatment planning, combining ideas from machine learning-automated planning and multicriteria optimization (MCO). Approach: Using knowledge extracted from historically delivered plans, prediction models for spatial dose and dose statistics are trained and furthermore systematically modified to simulate changes in tradeoff priorities, creating a set of differently biased predictions. Based on the predictions, an MCO problem is subsequently constructed using previously developed dose mimicking functions, designed in such a way…
MRI-guided radiation therapy (MRgRT) offers a precise and adaptive approach to treatment planning. Deep learning applications which augment the capabilities of MRgRT are systematically reviewed. MRI-guided radiation therapy offers a precise, adaptive approach to treatment planning. Deep learning applications which augment the capabilities of MRgRT are systematically reviewed with emphasis placed on underlying methods. Studies are further categorized into the areas of segmentation, synthesis, radiomics, and real time MRI. Finally, clinical implications, current challenges, and future directions…
We present a method of directly optimizing on deviations in clinical goal values in radiation therapy treatment planning. Using a new mathematical framework in which metrics derived from the dose-volume histogram are regarded as functionals of an auxiliary random variable, we are able to obtain volume-at-dose and dose-at-volume as infinitely differentiable functions of the dose distribution with easily evaluable function values and gradients. Motivated by the connection to risk measures in finance, which is formalized in this framework, we also derive closed-form formulas for mean-tail-dose an…
We demonstrate the application of mixture density networks (MDNs) in the context of automated radiation therapy treatment planning. It is shown that an MDN can produce good predictions of dose distributions as well as reflect uncertain decision making associated with inherently conflicting clinical tradeoffs, in contrast to deterministic methods previously investigated in literature. A two-component Gaussian MDN is trained on a set of treatment plans for postoperative prostate patients with varying extents to which rectum dose sparing was prioritized over target coverage. Examination on a test…
Introduction. Treatment planning systems (TPS) are an essential component for simulating and optimizing a radiation therapy treatment before administering it to the patient. It ensures that the tumor is well covered and the dose to the healthy tissues is minimized. However, the TPS provided by commercial companies often come with a large panel of tools, each implemented in the form of a black-box making it difficult for researchers to use them for implementing and testing new ideas. To address this issue, we have developed an open-source TPS. Approach. We have developed an open-source software…
Purpose: We present a framework for robust automated treatment planning using machine learning, comprising scenario-specific dose prediction and robust dose mimicking. Methods: The scenario dose prediction pipeline is divided into the prediction of nominal dose from input image and the prediction of scenario dose from nominal dose, each using a deep learning model with U-net architecture. By using a specially developed dose-volume histogram-based loss function, the predicted scenario doses are ensured sufficient target coverage despite the possibility of the training data being non-robust. Del…
We present an open-source platform to aid medical dosimetrists in preventing collisions between gantry head and patient or couch during photon or particle beam therapy treatment planning. This generic framework uses the native scripting interface of the particular planning software to import STL files of the treatment machine elements. These are visualized in 3D together with the contoured or scanned patient surface. A graphical dialog with sliders allows the interactive rotation of the gantry and couch, with real-time feedback. To prevent a future replanning, treatment planners can assess in …
We summarize recent results and ongoing activities in mathematical algorithms and computer science methods related to proton computed tomography (pCT) and intensity-modulated particle therapy (IMPT) treatment planning. Proton therapy necessitates a high level of delivery accuracy to exploit the selective targeting imparted by the Bragg peak. For this purpose, pCT utilizes the proton beam itself to create images. The technique works by sending a low-intensity beam of protons through the patient and measuring the position, direction, and energy loss of each exiting proton. The pCT technique allo…
Fast and accurate dose predictions are one of the bottlenecks in treatment planning for microbeam radiation therapy (MRT). In this paper, we propose a machine learning (ML) model based on a 3D U-Net. Our approach predicts separately the large doses of the narrow high intensity synchrotron microbeams and the lower valley doses between them. For this purpose, a concept of macro peak doses and macro valley doses is introduced, describing the respective doses not on a microscopic level but as macroscopic quantities in larger voxels. The ML model is trained to mimic full Monte Carlo (MC) data. Comp…
Pancreas stereotactic body radiotherapy treatment planning requires planners to make sequential, time consuming interactions with the treatment planning system (TPS) to reach the optimal dose distribution. We seek to develop a reinforcement learning (RL)-based planning bot to systematically address complex tradeoffs and achieve high plan quality consistently and efficiently. The focus of pancreas SBRT planning is finding a balance between organs-at-risk sparing and planning target volume (PTV) coverage. Planners evaluate dose distributions and make planning adjustments to optimize PTV coverage…
We give a scenario-based treatment plan optimization formulation that is equivalent to planning with geometric margins if the scenario doses are calculated using the static dose cloud approximation. If the scenario doses are instead calculated more accurately, then our formulation provides a novel robust planning method that overcomes many of the difficulties associated with previous scenario-based robust planning methods. In particular, our method protects only against uncertainties that can occur in practice, it gives a sharp dose fall-off outside high dose regions, and it avoids underdosage…
Objective: Radiation therapy treatment planning is a time-consuming, iterative process with potentially high inter-planner variability. Fully automated treatment planning processes could reduce a planner's active treatment planning time and remove inter-planner variability, with the potential to tremendously improve patient turnover and quality of care. In developing fully automated algorithms for treatment planning, we have two main objectives: to produce plans that are 1) Pareto optimal and 2) clinically acceptable. Here, we propose the Pareto optimal projection search (POPS) algorithm, whic…
Interfractional geometric uncertainties can lead to deviations of the actual delivered dose from the prescribed dose distribution. To better handle these uncertainties during treatment, the authors propose a dynamic framework for robust adaptive radiation therapy in which a variety of robust adaptive treatment strategies are introduced and evaluated. This variety is a result of optimization variables with various degrees of freedom within robust optimization models that vary in their grade of conservativeness. We formulate an adaptive framework with dependence on time and/or uncertainty or nei…
In recent years, volumetric modulated arc therapy (VMAT) has been becoming a more and more important radiation technique widely used in clinical application for cancer treatment. One of the key problems in VMAT is treatment plan optimization, which is complicated due to the constraints imposed by the involved equipments. In this paper, we consider a model with four major constraints: the bound on the beam intensity, an upper bound on the rate of the change of the beam intensity, the moving speed of leaves of the multi-leaf collimator (MLC) and its directional-convexity. We solve the model by a…
A new strategy for radiation therapy dosimetry planning (RTDP) used to reduce dose estimation errors due to respiratory motion in breast treatment was illustrated and evaluated in this study. On CT data set acquired for breast treatment, six different RTDP tangential techniques were performed: (i) three-dimensional conformal radiotherapy (3DCRT) with physical wedge, (ii) 3DCRT with virtual wedge, (iii) motion management technique (MMT) with physical wedge, (iv) MMT with virtual wedge, (v) 3DCRT with field-in-field, and (vi) intensity-modulated radiation therapy (IMRT) with direct aperture opti…
We present an optimization-based approach to radiation treatment planning over time. Our approach formulates treatment planning as an optimal control problem with nonlinear patient health dynamics derived from the standard linear-quadratic cell survival model. As the formulation is nonconvex, we propose a method for obtaining an approximate solution by solving a sequence of convex optimization problems. This method is fast, efficient, and robust to model error, adapting readily to changes in the patient's health between treatment sessions. Moreover, we show that it can be combined with the ope…
Auxiliary variables are often used to model a convex piecewise linear function in the framework of linear optimization. This work shows that such variables yield a block diagonal plus low rank structure in the reduced KKT system of the dual problem. We show how the structure can be detected efficiently, and derive the linear algebra formulas for an interior point method which exploit such structure. The structure is detected in 36% of the cases in Netlib. Numerical results on the inverse planning problem in radiation therapy show an order of magnitude speed-up compared to the state-of-the-art …
We apply the superiorization methodology to the intensity-modulated radiation therapy (IMRT) treatment planning problem. In superiorization, linear voxel dose inequality constraints are the fundamental modeling tool within which a feasibility-seeking projection algorithm will seek a feasible point. This algorithm is then perturbed with gradient descent steps to reduce a nonlinear objective function. Within the open-source inverse planning toolkit matRad, we implement a prototypical algorithmic framework for superiorization using the well-established Agmon, Motzkin, and Schoenberg (AMS) feasibi…
In the past decades mathematical optimization has found its way into radiation therapy and has made profound practice changing impact. Today, virtually all advanced treatment delivery methods, such as IMRT, VMAT, tomotherapy, LDR/HDR brachytherapy, proton therapy, are based on some form of optimization approach that changes the treatment variables (beam intensities, multileaf collimator shapes, beam angles, dwell times and seed or source positions) in the planning computer using an optimization algorithm, until the best value of the treatment (planning) objective has been found. It is fair to …
The problem of variable cell survival probability along the spread-out Bragg peak is one of the long standing problems in planning and optimisation of ion-beam therapy. This problem is considered using the multiscale approach to the physics of ion-beam therapy. The physical reasons for this problem are analysed and understood on a quantitative level. A recipe of solution to this problem is suggested using this approach. This recipe can be used in the design of a novel treatment planning and optimisation based on fundamental science.
Purpose: We propose a general framework for quantifying predictive uncertainties of dose-related quantities and leveraging this information in a dose mimicking problem in the context of automated radiation therapy treatment planning. Methods: A three-step pipeline, comprising feature extraction, dose statistic prediction and dose mimicking, is employed. In particular, the features are produced by a convolutional variational autoencoder and used as inputs in a previously developed nonparametric Bayesian statistical method, estimating the multivariate predictive distribution of a collection of p…
Radiotherapy is one of the main methods in the successful treatment of cancer. The tumor is irradiated with photons or charged particles (e.g. protons), and in the case of massive charged particles, the treatment results in less unnecessary dose outside the tumor and therefore less side effects for the patient and a faster recovery. However, the dose planning of hadron therapy is calculated from photon CT measurements, which results in large uncertainties in the planning and therefore in a necessary enlargement of the treatment area. This uncertainty can be reduced by performing the CT scan us…
Radiation therapy with carbon ions is a novel technique of cancer radiotherapy, applicable in particular to treating radioresistant tumours at difficult localisations. Therapy planning, where the medical physicist, following the medical prescription, finds the optimum distribution of cancer cells to be inactivated by their irradiation over the tumour volume, is a basic procedure of cancer radiotherapy. The main difficulty encountered in therapy planning for ion radiotherapy is to correctly account for the enhanced radiobiological effectiveness of ions in the Spread Out Bragg Peak (SOBP) region…
Cao et al (2018) published an article on inverse planning based on dose-averaged linear energy transfer (LET). Their claim that the problem can be cast as a linear optimization model relies on an incorrect application of the Charnes-Cooper transformation. In this comment we show that their linear model is simlar to one where dose-averaged LET is multiplied with dose, explaining why their model was nonetheless able to improve the LET distribution.
Background and purpose: The relative biological effectiveness (RBE) varies along the treatment field. However, in clinical practice, a constant RBE of 1.1 is assumed, which can result in undesirable side effects. This study provides an accurate overview of current clinical practice for considering proton RBE in Europe. Materials and Methods: A survey was devised and sent to all proton therapy centres in Europe that treat patients. The online questionnaire consisted of 39 questions addressing various aspects of RBE consideration in clinical practice, including treatment planning, patient follow…
Online adaptive radiation therapy (ART) has great promise to significantly reduce normal tissue toxicity and/or improve tumor control through real-time treatment adaptations based on the current patient anatomy. However, the major technical obstacle for clinical realization of online ART, namely the inability to achieve real-time efficiency in treatment re-planning, has yet to be solved. To overcome this challenge, this paper presents our work on the implementation of an intensity modulated radiation therapy (IMRT) direct aperture optimization (DAO) algorithm on graphics processing unit (GPU) …
UT Southwestern Medical Center（德克萨斯大学西南医学中心）；University of North Texas（北德克萨斯大学）；UCLouvain（鲁汶大学）；Erasmus University Medical Center（伊拉斯姆斯大学医学中心）
This work aims to study the generalizability of a pre-developed deep learning (DL) dose prediction model for volumetric modulated arc therapy (VMAT) for prostate cancer and to adapt the model to three different internal treatment planning styles and one external institution planning style. We built the source model with planning data from 108 patients previously treated with VMAT for prostate cancer. For the transfer learning, we selected patient cases planned with three different styles from the same institution and one style from a different institution to adapt the source model to four targ…
The purpose of this study is to determine whether organ sparing and target coverage can be simultaneously maintained for pencil beam scanning (PBS) proton therapy treatment of thoracic tumors in the presence of motion, stopping power uncertainties and patient setup variations. Ten consecutive patients that were previously treated with proton therapy to 66.6/1.8 Gy (RBE) using double scattering (DS) were replanned with PBS. Minimum and maximum intensity images from 4DCT were used to introduce flexible smearing in the determination of the beam specific PTV (BSPTV). Datasets from eight 4DCT phase…
We developed a novel method of creating intensity modulated proton arc therapy (IMPAT) plans that uses computing resources efficiently and may offer a dosimetric benefit for patients with ependymoma or similar tumor geometries. Our IMPAT planning method consists of a geometry-based energy selection step with major scanning spot contributions as inputs computed using ray-tracing and single-Gaussian approximation of lateral spot profiles. Based on the geometric relation of scanning spots and dose voxels, our energy selection module selects a minimum set of energy layers at each gantry angle such…
We present a method to include robustness into a multi-criteria optimization (MCO) framework for intensity-modulated proton therapy (IMPT). The approach allows one to simultaneously explore the trade-off between different objectives as well as the trade-off between robustness and nominal plan quality. In MCO, a database of plans each emphasizing different treatment planning objectives, is pre-computed to approximate the Pareto surface. An IMPT treatment plan that strikes the best balance between the different objectives can be selected by navigating on the Pareto surface. In our approach, robu…
In radiation therapy, mathematical methods have been used for optimizing treatment planning for delivery of sufficient dose to the cancerous cells while keeping the dose to critical surrounding structures minimal. This optimization problem can be modeled using mixed integer programming (MIP) whose solution gives the optimal beam orientation as well as optimal beam intensity. The challenge, however, is the computation time for this large scale MIP. We propose and investigate two novel heuristic approaches to reduce the computation time considerably while attaining high-quality solutions. We int…
Enabling Clinical Use of Linear Energy Transfer in Proton Therapy for Head and Neck Cancer -- A Review of Implications for Treatment Planning and Adverse Events Study
Cone beam computed tomography (CBCT) images can be used for dose calculation in adaptive radiation therapy (ART). The main challenges are the large artefacts and inaccurate Hounsfield unit (HU) values. Currently, deformed planning CT images are often used for this purpose, although anatomical accuracy might be a concern. Ideally, we would like to convert CBCT images to CT images with artifacts removed or greatly reduced and HU values corrected while keeping the anatomical accuracy. Recently, deep learning has achieved great success in image-to-image translation tasks. It is very difficult to a…
