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Inverse treatment planning of intensity modulated radiothrapy is a multicriteria optimization problem: planners have to find optimal compromises between a sufficiently high dose in tumor tissue that garantuee a high tumor control, and, dangerous overdosing of critical structures, in order to avoid high normal tissue complcication problems. The approach presented in this work demonstrates how to state a flexible generic multicriteria model of the IMRT planning problem and how to produce clinically highly relevant Pareto-solutions. The model is imbedded in a principal concept of Reverse Engineering, a general optimization paradigm for design problems. Relevant parts of the Pareto-set are approximated by using extreme compromises as cornerstone solutions, a concept that is always feasible if box constraints for objective funtions are available. A major practical drawback of generic multicriteria concepts trying to compute or approximate parts of the Pareto-set is the high computational effort. This problem can be overcome by exploitation of an inherent asymmetry of the IMRT planning problem and an adaptive approximation scheme for optimal solutions based on an adaptive clustering preprocessing technique. Finally, a coherent approach for calculating and selecting solutions in a real-timeinteractive decision-making process is presented. The paper is concluded with clinical examples and a discussion of ongoing research topics.

IMRT planning on adaptive volume structures – a significant advance of computational complexity
(2004)

In intensity-modulated radiotherapy (IMRT) planning the oncologist faces the challenging task of finding a treatment plan that he considers to be an ideal compromise of the inherently contradictive goals of delivering a sufficiently high dose to the target while widely sparing critical structures. The search for this a priori unknown compromise typically requires the computation of several plans, i.e. the solution of several optimization problems. This accumulates to a high computational expense due to the large scale of these problems - a consequence of the discrete problem formulation. This paper presents the adaptive clustering method as a new algorithmic concept to overcome these difficulties. The computations are performed on an individually adapted structure of voxel clusters rather than on the original voxels leading to a decisively reduced computational complexity as numerical examples on real clinical data demonstrate. In contrast to many other similar concepts, the typical trade-off between a reduction in computational complexity and a loss in exactness can be avoided: the adaptive clustering method produces the optimum of the original problem. This flexible method can be applied to both single- and multi-criteria optimization methods based on most of the convex evaluation functions used in practice

Radiation therapy planning is always a tight rope walk between dangerous insufficient dose in the target volume and life threatening overdosing of organs at risk. Finding ideal balances between these inherently contradictory goals challenges dosimetrists and physicians in their daily practice. Today’s planning systems are typically based on a single evaluation function that measures the quality of a radiation treatment plan. Unfortunately, such a one dimensional approach cannot satisfactorily map the different backgrounds of physicians and the patient dependent necessities. So, too often a time consuming iteration process between evaluation of dose distribution and redefinition of the evaluation function is needed. In this paper we propose a generic multi-criteria approach based on Pareto’s solution concept. For each entity of interest - target volume or organ at risk a structure dependent evaluation function is defined measuring deviations from ideal doses that are calculated from statistical functions. A reasonable bunch of clinically meaningful Pareto optimal solutions are stored in a data base, which can be interactively searched by physicians. The system guarantees dynamical planning as well as the discussion of tradeoffs between different entities. Mathematically, we model the upcoming inverse problem as a multi-criteria linear programming problem. Because of the large scale nature of the problem it is not possible to solve the problem in a 3D-setting without adaptive reduction by appropriate approximation schemes. Our approach is twofold: First, the discretization of the continuous problem is based on an adaptive hierarchical clustering process which is used for a local refinement of constraints during the optimization procedure. Second, the set of Pareto optimal solutions is approximated by an adaptive grid of representatives that are found by a hybrid process of calculating extreme compromises and interpolation methods.

Radiotherapy is one of the major forms in cancer treatment. The patient is irradiated with high-energetic photons or charged particles with the primary goal of delivering sufficiently high doses to the tumor tissue while simultaneously sparing the surrounding healthy tissue. The inverse search for the treatment plan giving the desired dose distribution is done by means of numerical optimization [11, Chapters 3-5]. For this purpose, the aspects of dose quality in the tissue are modeled as criterion functions, whose mathematical properties also affect the type of the corresponding optimization problem. Clinical practice makes frequent use of criteria that incorporate volumetric and spatial information about the shape of the dose distribution. The resulting optimization problems are of global type by empirical knowledge and typically computed with generic global solver concepts, see for example [16]. The development of good global solvers to compute radiotherapy optimization problems is an important topic of research in this application, however, the structural properties of the underlying criterion functions are typically not taken into account in this context.

Modeling and formulation of optimization problems in IMRT planning comprises the choice of various values such as function-specific parameters or constraint bounds. These values also affect the characteristics of the optimization problem and thus the form of the resulting optimal plans. This publication utilizes concepts of sensitivity analysis and elasticity in convex optimization to analyze the dependence of optimal plans on the modeling parameters. It also derives general rules of thumb how to choose and modify the parameters in order to obtain the desired IMRT plan. These rules are numerically validated for an exemplary IMRT planning problems.