Multiple direction needle-path planning and inverse dose optimization for robotic low-dose rate brachytherapy


Philipp AumüllerAndreas RothfussMartin PolednikYasser Abo-MadyanMichael EhmannFrank A GiordanoSven Clausen

Z Med Phys. 2021 Aug 6;S0939-3889(21)00061-1. doi: 10.1016/j.zemedi.2021.06.003 Online ahead of print.


Purpose: Robotic systems to assist needle placements for low-dose rate brachytherapy enable conformal dose planning only restricted to path planning around risk structures. We report a treatment planning system (TPS) combining multiple direction needle-path planning with inverse dose optimization algorithms.

Methods: We investigated in a path planning algorithm to efficiently locate needle injection points reaching the target volume without puncturing risk structures. A candidate needle domain with all combinations of trajectories is used for the optimization process. We report a modular algorithm for inverse radiation plan optimization. The initial plan with V100>99% is generated by the „greedy optimizer“. The „remove-seed algorithm“ reduces the number of seeds in the high dose regions. The „depth-optimizer“ varies the insertion depth of the needles. The „coverage-optimizer“ locates under-dosed areas in the target volume and supports them with an additional amount of seeds. The dose calculation algorithm is benchmarked on an image set of a phantom with a liver metastasis (prescription dose Dpr=100Gy) and is re-planned in a commercial CE-marked TPS to compare the calculated dose grids using a global gamma analysis. The inverse optimizer is benchmarked by calculating 10 plans on the same phantom to investigate the stability and statistical variability of the dose parameters.

Results: The path planning algorithm efficiently removes 72.5% of all considered injection points. The candidate needle domain consists of combinations of 1971 tip points and 827 injection points. The global gamma analysis with gamma 1%=2.9Gy, 1mm showed a pass rate of 98.5%. The dose parameters were V100=99.1±0.3%, V150=76.4±2.5%, V200=44.5±5.5% and D90=125.9±3.6Gy and 10.7±1.3 needles with 34.0±0.8 seeds were used. The median of the TPS total running time was 4.4minutes.

Conclusions: The TPS generates treatment plans with acceptable dose coverage in a reasonable amount of time. The gamma analysis shows good accordance to the commercial TPS. The TPS allows taking full advantage of robotic navigation tools to enable a new precise and safe method of minimally invasive low-dose-rate brachytherapy.

Keywords: Brachytherapy; Inverse optimization; LDR; Path planning; Robotic; Seeds.

Copyright © 2021. Published by Elsevier GmbH.