A two-stage sequential linear programming approach to IMRT dose optimization

A Hamiltonian Engine for Radiotherapy Optimization

We apply a new hardware and software platform called the Hamiltonian Engine for Radiotherapy Optimization (HERO) to the problem of Intensity-Modulated Radiation Therapy (IMRT) treatment planning. HERO solves large general-form binary optimization problems by decomposing them into sub-problems and approximating them using a quadratic pseudo-boolean function. Optimizing the resulting function becomes a quadratic unconstrained binary optimization (QUBO) problem, which has been widely studied and has numerous applications in various fields. A Quantum Annealer (QA) approach has been previously investigated to solve QUBO problems, including IMRT optimization. However, the QA can only accommodate a small number of variables and requires several hours to obtain optimized plans. HERO acts as an optimizer for QUBO problems, which not only addresses these shortcomings but also relies solely on conventional hardware design while operating at room temperature. We evaluate HERO on seven prostate IMRT cases with clinical objectives, each using approximately 6000 beamlets. Our method was compared to the commercial treatment planning software, Eclipse, for both time-to-solution and plan quality. HERO solves most cases in about 30 seconds, with significantly lower objective function scores than Eclipse. The results indicate that HERO is promising for radiation therapy optimization problems. Additionally, HERO has the potential to be applied to Volumetric-Modulated Arc Therapy (VMAT) and other complex types of treatment planning.

Modulated photon radiotherapy (XMRT): an algorithm for the simultaneous optimization of photon beamlet energy and intensity in external beam radiotherapy (EBRT) planning

This is a proof of principle study on an algorithm for optimizing external beam radiotherapy in terms of both photon beamlet energy and fluence. This simultaneous beamlet energy and fluence optimization is denoted modulated photon radiotherapy (XMRT). XMRT is compared with single-energy intensity modulated radiotherapy (IMRT) for five clinically relevant test geometries to determine whether treating beamlet energy as a decision variable improves the dose distributions. All test geometries were modelled in a cylindrical water phantom. XMRT optimized the fluence for 6 and 18 MV beamlets while IMRT optimized with only 6 MV and only 18 MV. CERR (computational environment for radiotherapy research) was used to calculate the dose deposition matrices and the resulting dose for XMRT and IMRT solutions. Solutions were compared via their dose volume histograms and dose metrics, such as the mean, maximum, and minimum doses for each structure. The homogeneity index (HI) and conformity number (CN) were calculated to assess the quality of the target dose coverage. Complexity of the resulting fluence maps was minimized using the sum of positive gradients technique. The results showed XMRT's ability to improve healthy-organ dose reduction while yielding comparable coverage of the target relative to IMRT for all geometries. All three energy-optimization approaches yielded similar HI and CNs for all geometries, as well as a similar degree of fluence map complexity. The dose reduction provided by XMRT was demonstrated by the relative decrease in the dose metrics for the majority of the organs at risk (OARs) in all geometries. Largest reductions ranged between 5% to 10% in the mean dose to OARs for two of the geometries when compared with both single-energy IMRT schemes. XMRT has shown potential dosimetric benefits through improved OAR sparing by allowing beam energy to act as a degree of freedom in the EBRT optimization process.

MCTP system model based on linear programming optimization of apertures obtained from sequencing patient image data maps

PURPOSE

The authors present a hybrid direct multileaf collimator (MLC) aperture optimization model exclusively based on sequencing of patient imaging data to be implemented on a Monte Carlo treatment planning system (MC-TPS) to allow the explicit radiation transport simulation of advanced radiotherapy treatments with optimal results in efficient times for clinical practice.

METHODS

The planning system (called CARMEN) is a full MC-TPS, controlled through aMATLAB interface, which is based on the sequencing of a novel map, called "biophysical" map, which is generated from enhanced image data of patients to achieve a set of segments actually deliverable. In order to reduce the required computation time, the conventional fluence map has been replaced by the biophysical map which is sequenced to provide direct apertures that will later be weighted by means of an optimization algorithm based on linear programming. A ray-casting algorithm throughout the patient CT assembles information about the found structures, the mass thickness crossed, as well as PET values. Data are recorded to generate a biophysical map for each gantry angle. These maps are the input files for a home-made sequencer developed to take into account the interactions of photons and electrons with the MLC. For each linac (Axesse of Elekta and Primus of Siemens) and energy beam studied (6, 9, 12, 15 MeV and 6 MV), phase space files were simulated with the EGSnrc/BEAMnrc code. The dose calculation in patient was carried out with the BEAMDOSE code. This code is a modified version of EGSnrc/DOSXYZnrc able to calculate the beamlet dose in order to combine them with different weights during the optimization process.

RESULTS

Three complex radiotherapy treatments were selected to check the reliability of CARMEN in situations where the MC calculation can offer an added value: A head-and-neck case (Case I) with three targets delineated on PET/CT images and a demanding dose-escalation; a partial breast irradiation case (Case II) solved with photon and electron modulated beams (IMRT + MERT); and a prostatic bed case (Case III) with a pronounced concave-shaped PTV by using volumetric modulated arc therapy. In the three cases, the required target prescription doses and constraints on organs at risk were fulfilled in a short enough time to allow routine clinical implementation. The quality assurance protocol followed to check CARMEN system showed a high agreement with the experimental measurements.

CONCLUSIONS

A Monte Carlo treatment planning model exclusively based on maps performed from patient imaging data has been presented. The sequencing of these maps allows obtaining deliverable apertures which are weighted for modulation under a linear programming formulation. The model is able to solve complex radiotherapy treatments with high accuracy in an efficient computation time.

Beam controlled arc therapy--a delivery concept for stationary targets

Volumetric modulated arc therapy (VMAT) presupposes that it is beneficial to deliver radiation from all beam angles as the gantry rotates, requiring the multi-leaf collimator to maintain continuity in shape from one angle to another. In turn, radiation from undesirable beam angles could compromise the dose distribution. In this work, we challenge the notion that the radiation beam must be held on as the gantry rotates around the patient. We propose a new approach for delivering intensity-modulated arc therapy, beam-controlled arc therapy (BCAT), during which the radiation beam is controlled on or off and the dose rate is modulated while the gantry rotates around the patient. We employ linear-programming-based dose optimization to each aperture weight, resulting in some zero weight apertures. During delivery, the radiation beam is held off at control points with zero weights as the MLC shape transits to the next non-zero weight shape. This was tested on ten head and neck cases. Plan quality and delivery efficiency were compared with VMAT. Improvements of up to 17% (p-value 0.001) and 57% (p-value 0.018) in organ-at-risk sparing and target dose uniformity, respectively, were achieved. Compared to the fixed number of apertures used in single-arc and double-arc VMAT, the BCAT used 109 and 175 apertures on average, respectively. The difference in total MUs for VMAT and BCAT plans was less than 4%. Plan quality improvement was confirmed after delivery with γ analysis resulting in over 99% agreement, or 4 in 1099 points that failed.