# Fast dose optimization for rotating shield brachytherapy

## TL;DR

This paper introduces a rapid convex optimization method using POGS for treatment planning in rotating shield brachytherapy, significantly reducing computation time while maintaining plan quality, thus facilitating clinical adoption.

## Contribution

The study presents a novel application of the POGS convex optimization solver for RSBT, achieving faster treatment plan calculations compared to traditional solvers like CPLEX.

## Key findings

- POGS achieved 18 times faster optimization than CPLEX.
- Treatment plan quality was comparable between POGS and CPLEX.
- The method enables rapid RSBT planning suitable for clinical use.

## Abstract

Purpose: To provide a fast computational method, based on the proximal graph solver (POGS) - a convex optimization solver using the alternating direction method of multipliers (ADMM), for calculating an optimal treatment plan in rotating shield brachytherapy (RSBT). RSBT treatment planning has more degrees of freedom than conventional high-dose-rate brachytherapy (HDR-BT) due to the addition of emission direction, and this necessitates a fast optimization technique to enable clinical usage. // Methods: The multi-helix RSBT (H-RSBT) delivery technique was considered with five representative cervical cancer patients. Treatment plans were generated for all patients using the POGS method and the previously considered commercial solver IBM CPLEX. The rectum, bladder, sigmoid, high-risk clinical target volume (HR-CTV), and HR-CTV boundary were the structures considered in our optimization problem, called the asymmetric dose-volume optimization with smoothness control. Dose calculation resolution was 1x1x3 mm^3 for all cases. The H-RSBT applicator has 6 helices, with 33.3 mm of translation along the applicator per helical rotation and 1.7 mm spacing between dwell positions, yielding 17.5 degree emission angle spacing per 5 mm along the applicator.// Results: For each patient, HR-CTV D90, HR-CTV D100, rectum D2cc, sigmoid D2cc, and bladder D2cc matched within 1% for CPLEX and POGS. Also, we obtained similar EQD2 figures between CPLEX and POGS. POGS was around 18 times faster than CPLEX. Over all patients, total optimization times were 32.1-65.4 seconds for CPLEX and 2.1-3.9 seconds for POGS. // Conclusions: POGS substantially reduced treatment plan optimization time around 18 times for RSBT with similar HR-CTV D90, OAR D2cc values, and EQD2 figure relative to CPLEX, which is significant progress toward clinical translation of RSBT. POGS is also applicable to conventional HDR-BT.