Fast and insightful bi-objective optimization for prostate cancer treatment planning with high-dose-rate brachytherapy

Purpose: Prostate high-dose-rate brachytherapy (HDR-BT) planning involves determining the movement that a high-strength radiation stepping source travels through the patient's body, such that the resulting radiation dose distribution sufficiently covers tumor volumes and safely spares nearby healthy organs from radiation risks. The Multi-Objective Real-Valued Gene-pool Optimal Mixing Evolutionary Algorithm (MO-RV-GOMEA) has been shown to be able to effectively handle this inherent bi-objective nature of HDR-BT planning. However, in clinical practice there is a very restricted planning time budget (often less than 1 h) for HDR-BT planning, and a considerable amount of running time needs to be spent before MO-RV-GOMEA finds a good trade-off front of treatment plans (about20–30 min on a single CPU core) with sufficiently accurate dose calculations, limiting the applicability of the approach in the clinic. To address this limitation, we propose an efficiency enhancement technique for MO-RV-GOMEA solving the bi-objective prostate HDR-BT planning problem.Methods: Dose-Volume (DV) indices are often used to assess the quality of HDR-BT plans. The accuracy of these indices depends on the number of dose calculation points at which radiation doses are computed. These are randomly uniformly sampled inside target volumes and organs at risk. In available HDR-BT planning optimization algorithms, the number of dose calculation points is fixed. The more points are used, the better the accuracy of the obtained results will be, but also the longer the algorithms need to be run. In this work, we introduce a so-called multi-resolution scheme that gradually increases the number of dose calculation points during the optimization run such that the running time can be substantially reduced without compromising on the accuracy of the obtained results.Results and conclusion: Experiments on a data set of 18 patient cases show that with the multi-resolution scheme, MO-RV-GOMEA can achieve a sufficiently good trade-off front of treatment plans after five minutes of running time on a single CPU core (4–6 times faster than the old approach with a fixed number of dose calculation points). When the optimization with the multi-resolution scheme is run on a quad-core machine, five minutes are enough to obtain trade-off fronts that are nearly as good as those obtained by running optimization with the old approach in one hour (i.e., 12 times faster). This leaves ample time to perform the selection of the preferred treatment plan from the trade-off front for the specific patient at hand. Furthermore, comparisons with real clinical treatment plans, which were manually made by experienced BT planners within 30–60 min, confirm that the plans obtained by our approach are superior in terms of DV indices. These results indicate that our proposed approach has the potential to be employed in clinical practice.</p

GPU-accelerated bi-objective treatment planning for prostate high-dose-rate brachytherapy

Purpose: The purpose of this study is to improve upon a recently introduced bi-objective treatment planning method for prostate high-dose-rate (HDR) brachytherapy (BT), both in terms of resulting

Robust optimization for HDR prostate brachytherapy applied to organ reconstruction uncertainty

Purpose. Recently, we introduced a bi-objective optimization approach based on dose-volume indices to automatically create clinically goodHDRprostate brachytherapy plans. To calculate dose-volume indices, a reconstruction algorithm is used to determine the 3D organ shape from 2D contours, inevitably containing settings that influence the result.Weaugment the optimization approach to quickly find plans that are robust to differences in 3D reconstruction. Methods. Studied reconstruction settings were: Interpolation between delineated organ contours, overlap between contours, and organ shape at the top and bottom contour. Two options for each setting yields 8 possible 3D organ reconstructions per patient, over which the robust model defines minimax optimization. For the original model, settings were based on our treatment planning system. Both models were tested on data of 26 patients and compared by re-evaluating selected optimized plans both in the original model (1 organ reconstruction, the difference determines the cost), and in the robust model (8 organ reconstructions, the difference determines the benefit). Results. Robust optimization increased the run time from 3 to 6 min. The median cost for robust optimization as observed in the original model was-0.25% in the dose-volume indices with a range of [-0.01%,-1.03%]. The median benefit of robust optimization as observed in the robust model was 0.93% with a range of [0.19%, 4.

Bi-objective optimization of catheter positions for high-dose-rate prostate brachytherapy

Purpose: Bi-objective simultaneous optimization of catheter positions and dwell times for high-dose-rate (HDR) prostate brachytherapy, based directly on dose-volume indices, has shown promising results. However, optimization with the state-of-the-art evolutionary algorithm MO-RV-GOMEA so far required several hours of runtime, and resulting catheter positions were not always clinically feasible. The aim of this study is to extend the optimization model and apply GPU parallelization to achieve clinically acceptable computation times. The resulting optimization procedure is compared with a previously introduced method based solely on geometric criteria, the adapted Centroidal Voronoi Tessellations (CVT) algorithm. Methods: Bi-objective simultaneous optimiz

Evaluation of bi-objective treatment planning for high-dose-rate prostate brachytherapy—A retrospective observer study

Purpose: Bi-objective treatment planning for high-dose-rate prostate brachytherapy is a novel treatment planning method with two separate objectives that represent target coverage and organ-at-risk sparing. In this study, we investigated the feasibility and plan quality of this method by means of a retrospective observer study.Methods and Materials: Current planning sessions were recorded to configure a bi-objective optimization model and to assess its applicability to our clinical practice. Optimization software, GOMEA, was then used to automatically generate a large set of plans with different trade-offs in the two objectives for each of 18 patients treated with high-dose-rate prostate brachytherapy. From this set, five plans per patient were selected for comparison to the clinical plan in terms of satisfaction of planning criteria and in a retrospective observer study. Three brachytherapists were asked to evaluate the blinded plans and select the preferred one.Results: Recordings demonstrated applicability of the bi-objective optimization model to our clinical practice. For 14/18 patients, GOMEA plans satisfied all planning criteria, compared with 4/18 clinical plans. In the observer study, in 53/54 cases, a GOMEA plan was preferred over the clinical plan. When asked for consensus among observers, this ratio was 17/18 patients. Observers highly appreciated the insight gained from comparing multiple plans with different trade-offs simultaneously.Conclusions: The bi-objective optimization model adapted well t

Towards artificial intelligence-based automated treatment planning in clinical practice: A prospective study of the first clinical experiences in high-dose-rate prostate brachytherapy

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