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Title: SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

Abstract

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dosemore » for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan adaptation. This research is financially supported by Elekta AB, Stockholm, Sweden.« less

Authors:
; ; ;  [1]; ; ;  [2]
  1. University Medical Center Utrecht, Utrecht (Netherlands)
  2. Erasmus University Medical Center Rotterdam, Rotterdam (Netherlands)
Publication Date:
OSTI Identifier:
22634714
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ANATOMY; ITERATIVE METHODS; LINEAR ACCELERATORS; OPTIMIZATION; PHANTOMS; PLANNING; PROSTATE; QUALITY ASSURANCE; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; SWEDEN

Citation Formats

Kontaxis, C, Bol, G, Lagendijk, J, Raaymakers, B, Breedveld, S, Sharfo, A, and Heijmen, B. SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation. United States: N. p., 2016. Web. doi:10.1118/1.4956013.
Kontaxis, C, Bol, G, Lagendijk, J, Raaymakers, B, Breedveld, S, Sharfo, A, & Heijmen, B. SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation. United States. doi:10.1118/1.4956013.
Kontaxis, C, Bol, G, Lagendijk, J, Raaymakers, B, Breedveld, S, Sharfo, A, and Heijmen, B. 2016. "SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation". United States. doi:10.1118/1.4956013.
@article{osti_22634714,
title = {SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation},
author = {Kontaxis, C and Bol, G and Lagendijk, J and Raaymakers, B and Breedveld, S and Sharfo, A and Heijmen, B},
abstractNote = {Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certain percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan adaptation. This research is financially supported by Elekta AB, Stockholm, Sweden.},
doi = {10.1118/1.4956013},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To develop a new sequencer for IMRT that during treatment can account for anatomy changes provided by online and real-time MRI. This sequencer employs a novel inter and intra fraction scheme that converges to the prescribed dose without a final segment weight optimization (SWO) and enables immediate optimization and delivery of radiation adapted to the deformed anatomy. Methods: The sequencer is initially supplied with a voxel-based dose prescription and during the optimization iteratively generates segments that provide this prescribed dose. Every iteration selects the best segment for the current anatomy state, calculates the dose it will deliver, warps itmore » back to the reference prescription grid and subtracts it from the remaining prescribed dose. This process continues until a certain percentage of dose or a number of segments has been delivered. The anatomy changes that occur during treatment require that convergence is achieved without a final SWO. This is resolved by adding the difference between the prescribed and delivered dose up to this fraction to the prescription of the subsequent fraction. This process is repeated for all fractions of the treatment. Results: Two breast cases were selected to stress test the pipeline by producing artificial inter and intra fraction anatomy deformations using a combination of incrementally applied rigid transformations. The dose convergence of the adaptive scheme over the entire treatment, relative to the prescribed dose, was on average 8.6% higher than the static plans delivered to the respective deformed anatomies and only 1.6% less than the static segment weighted plans on the static anatomy. Conclusion: This new adaptive sequencing strategy enables dose convergence without the need of SWO while adapting the plan to intermediate anatomies, which is a prerequisite for online plan adaptation. We are now testing our pipeline on prostate cases using clinical anatomy deformation data from our department. This work is financially supported by Elekta AB, Stockholm, Sweden.« less
  • Purpose: To determine planning target volume margins for prostate intensity-modulated radiotherapy based on inter- and intrafraction motion using four daily localization techniques: three-point skin mark alignment, volumetric imaging with bony landmark registration, volumetric imaging with implanted fiducial marker registration, and implanted electromagnetic transponders (beacons) detection. Methods and Materials: Fourteen patients who underwent definitive intensity-modulated radiotherapy for prostate cancer formed the basis of this study. Each patient was implanted with three electromagnetic transponders and underwent a course of 39 treatment fractions. Daily localization was based on three-point skin mark alignment followed by transponder detection and patient repositioning. Transponder positioning was verifiedmore » by volumetric imaging with cone-beam computed tomography of the pelvis. Relative motion between the prostate gland and bony anatomy was quantified by offline analyses of daily cone-beam computed tomography. Intratreatment organ motion was monitored continuously by the Calypso (registered) System for quantification of intrafraction setup error. Results: As expected, setup error (that is, inter- plus intrafraction motion, unless otherwise stated) was largest with skin mark alignment, requiring margins of 7.5 mm, 11.4 mm, and 16.3 mm, in the lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. Margin requirements accounting for intrafraction motion were smallest for transponder detection localization techniques, requiring margins of 1.4 mm (LR), 2.6 mm (SI), and 2.3 mm (AP). Bony anatomy alignment required 2.1 mm (LR), 9.4 mm (SI), and 10.5 mm (AP), whereas image-guided marker alignment required 2.8 mm (LR), 3.7 mm (SI), and 3.2 mm (AP). No marker migration was observed in the cohort. Conclusion: Clinically feasible, rapid, and reliable tools such as the electromagnetic transponder detection system for pretreatment target localization and, subsequently, intratreatment target location monitoring allow clinicians to reduce irradiated volumes and facilitate safe dose escalation, where appropriate.« less
  • Purpose: In radiation therapy treatment planning, the clinical objectives of uniform high dose to the planning target volume (PTV) and low dose to the organs-at-risk (OARs) are invariably in conflict, often requiring compromises to be made between them when selecting the best treatment plan for a particular patient. In this work, the authors introduce Pareto-Aware Radiotherapy Evolutionary Treatment Optimization (pareto), a multiobjective optimization tool to solve for beam angles and fluence patterns in intensity-modulated radiation therapy (IMRT) treatment planning. Methods: pareto is built around a powerful multiobjective genetic algorithm (GA), which allows us to treat the problem of IMRT treatmentmore » plan optimization as a combined monolithic problem, where all beam fluence and angle parameters are treated equally during the optimization. We have employed a simple parameterized beam fluence representation with a realistic dose calculation approach, incorporating patient scatter effects, to demonstrate feasibility of the proposed approach on two phantoms. The first phantom is a simple cylindrical phantom containing a target surrounded by three OARs, while the second phantom is more complex and represents a paraspinal patient. Results: pareto results in a large database of Pareto nondominated solutions that represent the necessary trade-offs between objectives. The solution quality was examined for several PTV and OAR fitness functions. The combination of a conformity-based PTV fitness function and a dose-volume histogram (DVH) or equivalent uniform dose (EUD) -based fitness function for the OAR produced relatively uniform and conformal PTV doses, with well-spaced beams. A penalty function added to the fitness functions eliminates hotspots. Comparison of resulting DVHs to those from treatment plans developed with a single-objective fluence optimizer (from a commercial treatment planning system) showed good correlation. Results also indicated that pareto shows promise in optimizing the number of beams. Conclusions: This initial evaluation of the evolutionary optimization software tool pareto for IMRT treatment planning demonstrates feasibility and provides motivation for continued development. Advantages of this approach over current commercial methods for treatment planning are many, including: (1) fully automated optimization that avoids human controlled iterative optimization and potentially improves overall process efficiency, (2) formulation of the problem as a true multiobjective one, which provides an optimized set of Pareto nondominated solutions refined over hundreds of generations and compiled from thousands of parameter sets explored during the run, and (3) rapid exploration of the final nondominated set accomplished by a graphical interface used to select the best treatment option for the patient.« less
  • Formal planning for climate change adaptation is emerging rapidly at a range of geo-political scales. This first generation of adaptation plans provides useful information regarding how institutions are framing the issue of adaptation and the range of processes that are recognized as being part of an adaptation response. To better understand adaptation planning among developed nations, a set of 57 adaptation plans from Australia, the United Kingdom and the United States was evaluated against a suite of 19 planning processes identified from existing guidance instruments for adaptation planning. Total scores among evaluated plans ranged from 16% of the maximum possiblemore » score to 61%, with an average of 37%. These results suggest adaptation plans are largely under-developed. Critical weaknesses in adaptation planning are related to limited consideration for non-climatic factors as well as neglect for issues of adaptive capacity including entitlements to various forms of capital needed for effective adaptation. Such gaps in planning suggest there are opportunities for institutions to make better use of existing guidance for adaptation planning and the need to consider the broader governance context in which adaptation will occur. In addition, the adaptation options prescribed by adaptation plans reflect a preferential bias toward low-risk capacity-building (72% of identified options) over the delivery of specific actions to reduce vulnerability. To the extent these findings are representative of the state of developed nation adaptation planning, there appear to be significant deficiencies in climate change preparedness, even among those nations often assumed to have the greatest adaptive capacity.« less
  • Purpose: To present a novel multi-criteria optimization (MCO) solution approach that generates well-dispersed representation of the Pareto front for radiation treatment planning. Methods: Different algorithms have been proposed and implemented in commercial planning software to generate MCO plans for external-beam radiation therapy. These algorithms consider convex optimization problems. We propose a grid-based algorithm to generate well-dispersed treatment plans over Pareto front. Our method is able to handle nonconvexity in the problem to deal with dose-volume objectives/constraints, biological objectives, such as equivalent uniform dose (EUD), tumor control probability (TCP), normal tissue complication probability (NTCP), etc. In addition, our algorithm is ablemore » to provide single MCO plan when clinicians are targeting narrow bounds of objectives for patients. In this situation, usually none of the generated plans were within the bounds and a solution is difficult to identify via manual navigation. We use the subproblem formulation utilized in the grid-based algorithm to obtain a plan within the specified bounds. The subproblem aims to generate a solution that maps into the rectangle defined by the bounds. If such a solution does not exist, it generates the solution closest to the rectangle. We tested our method with 10 locally advanced head and neck cancer cases. Results: 8 objectives were used including 3 different objectives for primary target volume, high-risk and low-risk target volumes, and 5 objectives for each of the organs-at-risk (OARs) (two parotids, spinal cord, brain stem and oral cavity). Given tight bounds, uniform dose was achieved for all targets while as much as 26% improvement was achieved in OAR sparing comparing to clinical plans without MCO and previously proposed MCO method. Conclusion: Our method is able to obtain well-dispersed treatment plans to attain better approximation for convex and nonconvex Pareto fronts. Single treatment plan can be achieved when given bounds on the objectives.« less