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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.

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

Background and purpose Inherently, IMRT treatment planning involves compromising between different planning goals. Multi-criteria IMRT planning directly addresses this compromising and thus makes it more systematic. Usually, several plans are computed from which the planner selects the most promising following a certain procedure. Applying Pareto navigation for this selection step simultaneously increases the variety of planning options and eases the identification of the most promising plan. Material and methods Pareto navigation is an interactive multi-criteria optimization method that consists of the two navigation mechanisms “selection” and “restriction”. The former allows the formulation of wishes whereas the latter allows the exclusion of unwanted plans. They are realized as optimization problems on the so-called plan bundle – a set constructed from precomputed plans. They can be approximately reformulated so that their solution time is a small fraction of a second. Thus, the user can be provided with immediate feedback regarding his or her decisions.