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Register a new userIPIP: A New Approach to Inverse Planning for HDR Brachytherapy by Directly Optimizing Dosimetric Indices
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Purpose: Many planning methods for high dose rate (HDR) brachytherapy treatment planning require an iterative approach. A set of computational parameters are hypothesized that will give a dose plan that meets dosimetric criteria. A dose plan is computed using these parameters, and if any dosimetric criteria are not met, the process is iterated until a suitable dose plan is found. In this way, the dose distribution is controlled by abstract parameters. The purpose of this study is to improve HDR brachytherapy planning by developing a new approach that directly optimizes the dose distribution based on dosimetric criteria. Method: We develop Inverse Planning by Integer Program (IPIP), an optimization model for computing HDR brachytherapy dose plans and a fast heuristic for it. We used our heuristic to compute dose plans for 20 anonymized prostate cancer patient image data sets from our clinic database. Dosimetry was evaluated and compared to dosimetric criteria. Results: Dose plans computed from IPIP satisfied all given dosimetric criteria for the target and healthy tissue after a single iteration. The average target coverage was 95%. The average computation time for IPIP was 30.1 seconds on a Intel(R) CoreTM2 Duo CPU 1.67 GHz processor with 3 Gib RAM. Conclusion: IPIP is an HDR brachytherapy planning system that directly incorporates dosimetric criteria. We have demonstrated that IPIP has clinically acceptable performance for the prostate cases and dosimetric criteria used in this study, both in terms of dosimetry and runtime. Further study is required to determine if IPIP performs well for a more general group of patients and dosimetric criteria, including other cancer sites such as GYN.
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Purpose: To determine whether alternative HDR prostate brachytherapy catheter patterns can result in improved dose distributions while providing better access and reducing trauma. Methods: Prostate HDR brachytherapy uses a grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. On CT data from ten previously-treated patients new catheters were digitized following three catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage. Results: Thirty plans from ten patients were optimized. All non-standard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of catheter insertion. In addition, alternative catheter patterns may decrease toxicity by avoidance of the critical structures near the penile bulb while still fulfilling the RTOG criteria.
Purpose: We sought to evaluate the feasibility of using machine learning algorithms for multipoint plastic scintillator detector calibration in high-dose-rate brachytherapy. Methods: The dosimetry system consisted of an optimized 1-mm-core mPSD and a compact assembly of photomultiplier tubes coupled with dichroic mirrors and filters. An $^{192}$Ir source was remotely controlled and sent to various positions in a homemade PMMA holder. Dose measurements covering a range of 0.5 to 12 cm of source displacement were carried out according to TG-43 recommendations. Individual scintillator doses were decoupled using a linear regression model, a random forest estimator, and artificial neural network algorithms. The performance of the different algorithms was evaluated using different sample sizes and distances to the source for the mPSD system calibration. Results: The decoupling methods deviations from the expected TG-43 dose generally remained below 20%. However, the dose prediction with the three algorithms was accurate to within 7% relative to the dose predicted by the TG-43 formalism for measurements performed in the same range of distances used for calibration. The performance random forest was compromised when the predictions were done beyond the range of distances used for calibration. The dose prediction by the linear regression was less influenced by the calibration conditions than random forest, but with more significant deviations. The number of available measurements for training purposes influenced the random forest and neural network models the most. Their accuracy tended to converge toward deviation values close to 1% from a number of dwell positions greater than 100. Conclusions: In performing HDR brachytherapy dose measurements with an optimized mPSD system, ML algorithms are good alternatives for precise dose reporting and treatment assessment.
Inverse treatment planning in radiation therapy is formulated as optimization problems. The objective function and constraints consist of multiple terms designed for different clinical and practical considerations. Weighting factors of these terms are needed to define the optimization problem. While a treatment planning system can solve the optimization problem with given weights, adjusting the weights for high plan quality is performed by human. The weight tuning task is labor intensive, time consuming, and it critically affects the final plan quality. An automatic weight-tuning approach is strongly desired. The weight tuning procedure is essentially a decision making problem. Motivated by the tremendous success in deep learning for decision making with human-level intelligence, we propose a novel framework to tune the weights in a human-like manner. Using treatment planning in high-dose-rate brachytherapy as an example, we develop a weight tuning policy network (WTPN) that observes dose volume histograms of a plan and outputs an action to adjust organ weights, similar to the behaviors of a human planner. We train the WTPN via end-to-end deep reinforcement learning. Experience replay is performed with the epsilon greedy algorithm. Then we apply the trained WTPN to guide treatment planning of testing patient cases. The trained WTPN successfully learns the treatment planning goals to guide the weight tuning process. On average, the quality score of plans generated under the WTPNs guidance is improved by ~8.5% compared to the initial plan with arbitrary weights, and by 10.7% compared to the plans generated by human planners. To our knowledge, this is the first tool to adjust weights for the treatment planning in a human-like fashion based on learnt intelligence. The study demonstrates potential feasibility to develop intelligent treatment planning system via deep reinforcement learning.
High dose-rate brachytherapy (HDRBT) is widely used for gynecological cancer treatment. Although commercial treatment planning systems (TPSs) have inverse optimization modules, it takes several iterations to adjust planning objectives to achieve a satisfactory plan. Interactive plan-modification modules enable modifying the plan and visualizing results in real time, but they update plans based on simple geometrical or heuristic algorithms, which cannot ensure resulting plan optimality. This project develops an interactive plan optimization module for HDRBT of gynecological cancer. By efficiently solving an optimization problem in real time, it allows a user to visualize a plan and interactively modify it to improve quality. We formulated an optimization problem with an objective function containing a weighted sum of doses to normal organs subject to user-specified target coverage. A user interface was developed that allows a user to adjust organ weights using scroll bars. With a simple mouse click, the optimization problem is solved in seconds with a highly efficient alternating-direction method of multipliers and a warm start optimization strategy. Resulting clinically relevant D2cc of organs are displayed immediately. This allows a user to intuitively adjust plans with satisfactory quality. We tested the effectiveness of our development in cervix cancer cases treated with a tandem-and-ovoid applicator. It took a maximum of 3 seconds to solve the optimization problem in each instance. With interactive optimization capability, a satisfactory plan can be obtained in <1 min. In our clinic, although the time for plan adjustment was typically <10min with simple interactive plan modification tools in TPS, the resulting plans do not ensure optimality. Our plans achieved on average 5% lower D2cc than clinical plans, while maintaining target coverage.
We have previously described RapidBrachyMCTPS, a brachytherapy treatment planning toolkit consisting of a graphical user interface (GUI) and a Geant4-based Monte Carlo (MC) dose calculation engine. This work describes the tools that have recently bee
n added to RapidBrachyMCTPS, such that it now serves as the first stand-alone application for MC-based brachytherapy treatment planning. Notable changes include updated applicator import and positioning, three-plane contouring tools, and updated dose optimization algorithms that, in addition to optimizing dwell position and dwell time, also optimize the rotating shield angles in intensity modulated brachytherapy. The main modules of RapidBrachyMCTPS were validated including DICOM import, applicator import and positioning, contouring, material assignment, source specification, catheter reconstruction, EGSphant generation, interface with the MC code, and dose optimization and analysis tools. Two patient cases were simulated to demonstrate these principles, illustrating the control and flexibility offered by RapidBrachyMCTPS for all steps of the treatment planning pathway. RapidBrachyMCTPS is now a stand-alone application for brachytherapy treatment planning, and offers a user-friendly interface to access powerful MC calculations. It can be used to validate dose distributions from clinical treatment planning systems or model-based dose calculation algorithms, and is also well suited to testing novel combinations of radiation sources and applicators, especially those shielded with high-Z materials.
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