A new concept for interactive radiotherapy planning with multicriteria optimization: First clinical evaluation

Background and purposeCurrently, inverse planning for intensity-modulated radiotherapy (IMRT) can be a time-consuming trial and error process. This is because many planning objectives are inherently contradictory and cannot reach their individual optimum all at the same time. Therefore in clinical practice the potential of IMRT cannot be fully exploited for all patients. Multicriteria (multiobjective) optimization combined with interactive plan navigation is a promising approach to overcome these problems.Patients and methodsWe developed a new inverse planning system called “Multicriteria Interactive Radiotherapy Assistant (MIRA)”. The optimization result is a database of patient specific, Pareto-optimal plan proposals. The database is explored with an intuitive user interface that utilizes both a new interactive element for plan navigation and familiar dose visualizations in form of DVH and isodose projections. Two clinical test cases, one paraspinal meningioma case and one prostate case, were optimized using MIRA and compared with the clinically approved planning program KonRad.ResultsGenerating the databases required no user interaction and took approx. 2–3 h per case. The interactive exploration required only a few minutes until the best plan was identified, resulting in a significant reduction of human planning time. The achievable plan quality was comparable to KonRad with the additional benefit of having plan alternatives at hand to perform a sensitivity analysis or to decide for a different clinical compromise.ConclusionsThe MIRA system provides a complete database and interactive exploration of the solution space in real time. Hence, it is ideally suited for the inherently multicriterial problem of inverse IMRT treatment planning.