Automatic plan selection using deep network-A prostate study

Recently, high-dose-rate (HDR) brachytherapy treatment plans generation was improved with the development of multicriteria optimization (MCO) algorithms that can generate thousands of pareto optimal plans within seconds. This brings a shift, from the objective of generating an acceptable plan to choosing the best plans out of thousands. In order to choose the best plans, new criteria beyond usual dosimetrics volumes histogram (DVH) metrics are introduced and a deep learning (DL) framework is added as an automatic plan selection algorithm. The new criteria are visual-like criteria implemented for the bladder, rectum, and urethra. One criterion also takes into account the cold spot in the prostate. Those criteria, along with commonly used DVH criteria, are used to form classes on which to train the algorithm. The algorithm is trained with an input of two 3D images, dose and mask of the anatomy, in order to rank and automatically select a plan. The confidence in the output is used for ranking and the automatic plan selection. The algorithm is trained on 835 previously treated prostate cancer patients and evaluated on a separated 20 patients cohort previously evaluated by two experts (clinical medical physicists) in an inter-observer MCO study. The deep network takes 10 s to rank 2000 plans (vs. 5-10 min for experts to rank 4 preferred plans). A total of four different networks are trained which offer different trade-offs. The key trade-offs are the target coverage or the organs at risk (OAR) sparing. The algorithm with the best network achieves no statistical difference with the plans chosen by the two experts for 6 and 9 criteria, respectively, out of 13 criteria (paired t-test with p 0.05) while the two experts have no statistical difference between them for 7 criteria. The developed approach is flexible since it allows the modification or addition of criteria to obtain different trade-offs in plan quality, per the institution standard. The approach is fast and robust while adding negligible time to MCO planning. These results demonstrate potential for clinical use.