Catheters and dose optimization using a modified CVT algorithm and multi-criteria optimization in prostate HDR brachytherapy

Purpose Currently, in high-dose rate (HDR) brachytherapy planning, the catheter's positions are often selected by the planner, which involves the planner's experience. The catheters are then inserted using a template that helps to guide the catheters. For certain applications, it is of interest to choose the optimal location and number of catheters needed for dose coverage and potential decrease of the treatment's toxicity. Hence, it is of great importance to develop patient-specific algorithms for catheters and dose optimization. Methods A modified Centroidal Voronoi tessellation (CVT) algorithm is implemented and merged with a graphics processing unit (GPU)-based multi-criteria optimization algorithm (gMCO). The CVT algorithm optimizes the catheters' positions, and the gMCO algorithm optimizes the dwell times and dwell positions. The CVT algorithm can be used simultaneously for insertion with or without a template. Some improvements to the CVT algorithm are presented such as a new way of considering the area that needs to be covered. One hundred eight previously treated prostates HDR cases using real-time ultrasound are used to evaluate the different optimization procedures. The plan robustness is evaluated using two types of errors: deviations (random) in the insertion and deviation (systematic) in the reconstruction of the catheters. Results Using gMCO on clinically inserted catheter increases the acceptance rate by 37% for Radiation Therapy Oncology Group (RTOG) criteria. Our results show that all the patients respect RTOG criteria with 11 catheters using CVT+gMCO with a template of 5 mm. The number of catheters needed for all patients to respect RTOG criteria with the freehand technique is 10 catheters using CVT+gMCO. When deviations are introduced, using a template, the acceptance rate goes to 85% with 3 mm deviations using 11 catheters. This decrease is less significant when the number of catheters is higher, decreasing by less than 5% with a 3 mm deviation using 13 catheters or more. In conclusion, it is feasible to decrease the number of catheters needed to treat most patients. Conclusions Some cases still need a high number of catheters to reach the plan's criteria. Using gMCO allows an increase in the plan quality, while using CVT reduces the number of catheters. A higher number of catheters equates to plans that are more robust to deviations.