Are we likely to have automated radiotherapy treatment planning?

David P. Gierga, PhD
Massachusetts General Hospital, Boston

Automated treatment planning is on the way

The goal of treatment planning in external beam radiotherapy is to implement the radiation oncologist’s prescription in the most optimal way.  Treatment planning requires sophisticated tools but, for the sizable part, it is a manual, time-consuming process requiring multiple iterations to reach the desired goal.  While some methods, such as multi-criteria optimization (Craft et al 2007), have been introduced to provide an optimal treatment plan with fewer iterations, significant effort is still required to progress through the treatment planning workflow.

Automated treatment planning has been proposed as a method to increase efficiency, ensure consistent plan quality, or to simply enable treatment planning in resource limited settings.  One example of automated planning, knowledge-based planning, utilizes information from prior plans to predict the dose for future individual patients, based on their specific anatomy (Appenzoller et al 2012).  Recently, knowledge-based planning has been used as a quality control tool for clinical trials and resulted in improved normal tissue sparing (Li et al 2017).  Knowledge-based planning has also been used to automatically generate plans for stereotactic radiosurgery (Ziemer et al 2017).  More recently, Kisling et al have developed a Radiation Planning Assistant, specifically developed for limited resource settings, to automatically generate plans for post-mastectomy radiation therapy.

Machine learning will also likely be utilized for a higher degree of automated treatment planning in the near future, with recent examples published by Nguyen et al for dose prediction for prostate and head and neck cancer patients.  Finally, a recent publication by Zarepisheh et al successfully demonstrated that hierarchical constrained optimization can also be used for automatic intensity modulated radiation therapy (IMRT) treatment planning.  In summary, multiple techniques have been developed for automated treatment planning, and will likely become prevalent within the next few years.


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