A Digital Twin Framework for Adaptive Treatment Planning in Radiotherapy

TL;DR

This paper introduces a digital twin framework that enables rapid, adaptive proton therapy planning for prostate SBRT, significantly reducing reoptimization time while maintaining or improving plan quality and organ safety.

Contribution

The proposed digital twin framework integrates deep learning, daily imaging, and knowledge-based evaluation to facilitate real-time adaptive treatment planning in prostate radiotherapy.

Findings

Reoptimization time reduced to an average of 5.5 minutes.

Plan quality scores matched or exceeded clinical plans.

Effective dose minimization to organs at risk.

Abstract

The development of a digital twin (DT) framework for fast online adaptive proton therapy planning in prostate stereotactic body radiation therapy (SBRT) with dominant intraprostatic lesion (DIL) boost represents a significant advancement in personalized radiotherapy. This framework integrates deep learning-based multi-atlas deformable image registration, daily patient anatomy updates via cone-beam CT (CBCT), and knowledge-based plan quality evaluation using the ProKnow scoring system to achieve clinical-equivalent plan quality with substantially reduced reoptimization times compared to traditional clinical workflows. Drawing on a database of 43 prior prostate SBRT cases, the DT framework predicts interfractional anatomical variations for new patients and pre-generates multiple probabilistic treatment plans. Upon acquiring daily CBCT, it enables rapid plan reoptimization, achieving an average reoptimization time of 5.5 [2.8, 8.2] minutes, compared to 19.8 [7.9, 31.7] minutes for clinical plans. The DT-based plans yielded a plan quality score of 157.2 [151.6, 162.8], surpassing or matching clinical plans, with superior dose coverage for the DIL (V100: 99.5%) and clinical target volume (CTV V100: 99.8%). Additionally, the framework minimized doses to organs at risk (OARs), achieving bladder V20.8Gy of 11.4 [7.2, 15.6] cc, rectum V23Gy of 0.7 [0.3, 1.1] cc, and urethra D10 of 90.9% [88.6%, 93.2%], aligning with clinical standards. By addressing interfractional variations efficiently, the DT framework enhances treatment precision, reduces OAR toxicity, and supports real-time adaptive radiotherapy. This transformative approach not only streamlines the planning process but also improves clinical outcomes, offering a scalable solution for prostate SBRT with DIL boost and paving the way for broader applications in adaptive proton therapy.