Automatic Configuration of Fast Automated Multi‐Objective Treatment Planning in Radiotherapy

At Erasmus MC, automated plan generation is used to treat cancer patients. The system for automated planning is called Erasmus-iCycle which is used to consistently generate a high-quality and Pareto-optimal treatment plan with optimized beam directions for each patient. In this thesis, a new planning method, the lexicographic reference point method (LRPM), was developed and implemented in Erasmus-iCycle. The LRPM aims to improve the clinically used planning method in Erasmus-iCycle in two ways. Firstly, the LRPM should decrease the computation time of automatically generating a plan without compromising in

Automatic configuration of the reference point method for fully automated multi-objective treatment planning applied to oropharyngeal cancer

Purpose: In automated treatment planning, configuration of the underlying algorithm to generate high-quality plans for all patients of a particular tumor type can be a major challenge. Often, a time-consuming trial-and-error tuning procedure is required. The purpose of this paper is to automatically configure an automated treatment planning algorithm for oropharyngeal cancer patients. Methods: Recently, we proposed a new procedure to automatically configure the reference point method (RPM), a fast automatic multi-objective treatment planning algorithm. With a well-tuned configuration, the RPM generates a single Pareto optimal treatment plan with clinically favorable trade-offs for each patient. The automatic configuration of the RPM requires a set of computed tomography (CT) scans with corresponding dose distributions for training. Previously, we demonstrated for prostate cancer planning with 12 objectives th

Plan-library supported automated replanning for online-adaptive intensity-modulated proton therapy of cervical cancer

Background: Intensity-modulated proton therapy is sensitive to inter-fraction variations, including density changes along the pencil-beam paths and variations in organ-shape and location. Large dayto-day variations are seen for cervical cancer patients. The purpose of this study was to develop and evaluate a novel method for online selection of a plan from a patient-specific library of prior plans for different anatomies, and adapt it for the daily anatomy. Material and methods: The patient-specific library of prior plans accounting for altered target geometries was generated using a pretreatment established target motion model. Each fraction, the best fitting prior plan was selected. This prior plan was adapted using (1) a restoration of spot-positions (Bragg peaks) by adapting the energies to the new water equivalent path lengths; and (2) a spot addition to fully cover the target of the day, followed by a fast optimization of the spot-weights with the reference point method (RPM) to obtain a Pareto-optimal plan for the daily anatomy. Spot addition and spot-weight optimization could be repeated iteratively. The patient cohort consisted of six patients with in total 23 repeat-CT scans, with a prescribed dose of 45 Gy(RBE) to the primary tumor and the nodal CTV. Using a 1-plan-library (one prior plan based on all motion in the motion model) was compared to choosing from a 2-plan-library (two prior plans based on part of the motion). Results: Applying the prior-plan adaptation method with one iteration of adding spots resulted in clinically acceptable target coverage (V95% 95% and V107% 2%) for 37/46 plans using the 1-planlibrary and 41/46 plans for the 2-plan-library. When adding spots twice, the 2-plan-library approach could obtain acceptable coverage for all scans, while the 1-plan-library approach showed V107% > 2% for 3/46 plans. Similar OAR results were obtained. Conclusion: The automated prior-plan adaptation method can successfully adapt for the large day-today variations observed in cervical cancer patients