Multiple direction needle-path planning and inverse dose optimization for robotic low-dose rate brachytherapy.

Abstract Purpose Robotic systems to assist needle placements for low-dose rate brachytherapy enable conformal dose planning only restricted to path planning around risk structures. We report a treatment planning system (TPS) combining multiple direction needle-path planning with inverse dose optimization algorithms. Methods We investigated in a path planning algorithm to efficiently locate needle injection points reaching the target volume without puncturing risk structures. A candidate needle domain with all combinations of trajectories is used for the optimization process. We report a modular algorithm for inverse radiation plan optimization. The initial plan with V100 >  99% is generated by the “greedy optimizer”. The “remove-seed algorithm” reduces the number of seeds in the high dose regions. The “depth-optimizer” varies the insertion depth of the needles. The “coverage-optimizer” locates under-dosed areas in the target volume and supports them with an additional amount of seeds. The dose calculation algorithm is benchmarked on an image set of a phantom with a liver metastasis (prescription dose D p r = 100 Gy ) and is re-planned in a commercial CE-marked TPS to compare the calculated dose grids using a global gamma analysis. The inverse optimizer is benchmarked by calculating 10 plans on the same phantom to investigate the stability and statistical variability of the dose parameters. Results The path planning algorithm efficiently removes 72.5% of all considered injection points. The candidate needle domain consists of combinations of 1971 tip points and 827 injection points. The global gamma analysis with gamma 1 % = 2.9 Gy , 1 mm showed a pass rate of 98.5 % . The dose parameters were V 100 = 99.1 ± 0.3 % , V 150 = 76.4 ± 2.5 % , V 200 = 44.5 ± 5.5 % and D 90 = 125.9 ± 3.6 Gy and 10.7 ± 1.3 needles with 34.0 ± 0.8 seeds were used. The median of the TPS total running time was 4.4 minutes. Conclusions The TPS generates treatment plans with acceptable dose coverage in a reasonable amount of time. The gamma analysis shows good accordance to the commercial TPS. The TPS allows taking full advantage of robotic navigation tools to enable a new precise and safe method of minimally invasive low-dose-rate brachytherapy.