Real-Time Radiation Treatment Planning with Optimality Guarantees via Cluster and Bound Methods

B. Ungun, L. Xing, and S. Boyd

INFORMS Journal on Computing, 31(3): 544–58, 2019.

Radiation therapy is widely used in cancer treatment; however, plans necessarily involve tradeoffs between tumor coverage and damage to healthy tissue. While current hardware can deliver custom-shaped beams from any angle around the patient, choosing (from all possible beams) an optimal set of beams that maximizes tumor coverage and while minimizing collateral damage and treatment time is intractable. Furthermore, even though planning algorithms used in practice consider highly restricted sets of candidate beams, the time per run combined with the number of runs required to explore clinical tradeoffs results in planning times of hours to days. We propose a suite of cluster and bound methods that we hypothesize will (a) yield higher quality plans by optimizing over much (i.e., 100-fold) larger sets of candidate beams, and/or (b) reduce planning time by allowing clinicians to search through candidate plans in real time. Our methods hinge on phrasing the treatment planning problem as a convex problem. To handle large scale optimizations, we form and solve compressed approximations to the full problem by clustering beams (i.e., columns of the dose influence matrix used in the optimization) or voxels (rows of the matrix). Duality theory allows us to bound the error incurred when applying an approximate problem's solution to the full problem. We observe that beam clustering and voxel clustering both yield excellent solutions while enabling a 10–200-fold speedup.