arXiv subjects

Sebastiaan Breedveld

Publications and source records attributed to Sebastiaan Breedveld.

4 recordsLinked to original sources

arXiv2026

Direct probabilistic IMPT treatment planning with setup and range errors for neuro-oncological patients

To show clinical feasibility of a previously proposed probabilistic planning approach that can precisely optimize for clinical goals with patient-specific acceptance probabilities on a neuro-oncological patient group, we compared probabilistic plans with (automated) robust plans for one patient (group A) that could achieve sufficient clinical target coverage and for four patients (group B) where target coverage had to be compromised due to organ-at-risk (OAR) dose constraints. The probabilistic approach is percentile-based and uses the fact that a (dose) percentile can be approximated as a linear combination of its expected value and standard deviation. The optimization has a nested structure: the inner optimization optimizes the beam weights for a given percentile estimate, while an outer loop iteratively updates and improves the accuracy of the percentile estimate. For every outer iteration, the optimization is warm-started from the previous iteration. Percentiles are efficiently calculated by sampling a polynomial chaos expansion of the dose-influence matrix. The patient in group A achieved cumulative OAR dose reductions (of OAR-related DVH-metrics) of 19 GyRBE, for identical target coverage. Target coverage improved for all patients in group B (the 10th percentile of $D_{99.8\%}$ increased up to 0.93 GyRBE), at the same time reaching cumulative OAR dose reductions (of OAR-related DVH-metrics) up to 33 GyRBE. Probabilistic plans were optimized in 44h to 141h. For two representative patients, eliminating warm-starting (i.e., the outer loop) from the approach reduced total optimization times to below 10h (which took originally 80h and 141h). Compared to robust optimization methods, the probabilistic approach achieves improved trade-offs between probabilistic target coverage and OAR sparing, potentially leading to better treatments.

physics.med-ph↗

arXiv2026

Sparse probabilistic evaluation for treatment planning: a feasibility study in IMPT head & neck patients

Probabilistic evaluation improves the trade-off between target coverage and OAR sparing in IMPT but remains computationally demanding. This study proposes sparse probabilistic evaluation (SPE), a computationally efficient approach integrated into a clinical TPS. Clinical plans of 20 IMPT HNC patients treated in 2024 were included. SPE used a predefined setup and range error grid with Monte Carlo computed dose distributions. Two grid settings were evaluated: the maximum error Emax (3$\sigma$ or 4$\sigma$) and the number of setup error points nsetup (7, 33, 123). Accuracy and duration of SPE with each grid were evaluated in the calibration group (5 patients). 1000 treatments with normally distributed random ($\sigma$ = 1 mm) and systematic ($\sigma$ = 0.92 mm) setup and range ($\sigma$ = 1.5%) errors were simulated. The dose distribution of the nearest error point in the grid was assigned to each fraction. Probability distributions derived from SPE were compared with those from a reference based on 35,000 Monte Carlo calculations. The found optimal grid (Emax = 3$\sigma$, nsetup = 33) was applied to the validation group (15 patients). Accuracy of SPE in the calibration group increased significantly as the number of error points increased from 7 (tavg = 2 minutes) to 33 (tavg = 9 minutes), with no further improvement between 33 and 123 (tavg = 27 minutes) error points. Increasing Emax only improved accuracy for values above the 98th percentile. Applying SPE to the validation group resulted in median errors of 0.02 Gy RBE (range:-0.11 to 0.07) for the 10th percentile of the D99.8%, CTV distribution and 0.0 Gy RBE (range:-0.14 to 0.23) for the 95th percentile of the D0.03cc,SpinalCord Core distribution. Sparse probabilistic evaluation achieves sufficient accuracy while requiring clinically acceptable computation times, paving the way for probabilistic evaluation in clinical practice.

physics.med-ph↗

arXiv2025

Probabilistic Proton Treatment Planning: a novel approach for optimizing underdosage and overdosage probabilities of target and organ structures

Treatment planning uncertainties are typically managed using margin-based or robust optimization. Margin-based methods expand the clinical target volume (CTV) to a planning target volume, generally unsuited for proton therapy. Robust optimization considers worst-case scenarios, but its quality depends on the uncertainty scenario set: excluding extremes reduces robustness, while too many make plans overly conservative. Probabilistic optimization overcomes these limits by modeling a continuous scenario distribution. We propose a novel probabilistic optimization approach that steers plans toward individualized probability levels to control CTV and organs-at-risk (OARs) under- and overdosage. Voxel-wise dose percentiles ($d$) are estimated by expected value ($E$) and standard deviation (SD) as $E[d] \pm \delta \cdot SD[d]$, where $\delta$ is iteratively tuned to match the target percentile given Gaussian-distributed setup (3 mm) and range (3%) uncertainties. The method involves an inner optimization of $E[d] \pm \delta \cdot SD[d]$ for fixed $\delta$, and an outer loop updating $\delta$. Polynomial Chaos Expansion (PCE) provides accurate and efficient dose estimates during optimization. We validated the method on a spherical CTV abutted by an OAR in different directions and a horseshoe-shaped CTV surrounding a cylindrical spine. For spherical cases with similar CTV coverage, $P(D_{2\%} > 30 Gy)$ dropped by 10-15%; for matched OAR dose, $P(D_{98\%} > 57 Gy)$ increased by 67.5-71%. In spinal plans, $P(D_{98\%} > 57 Gy)$ increased by 10-15% while $P(D_{2\%} > 30 Gy)$ dropped 24-28%. Probabilistic and robust optimization times were comparable for spherical (hours) but longer for spinal cases (7.5 - 11.5 h vs. 9 - 20 min). Compared to discrete scenario-based optimization, the probabilistic method offered better OAR sparing or target coverage depending on the set priorities.

physics.med-ph↗

arXiv2020

Dose Prediction with Deep Learning for Prostate Cancer Radiation Therapy: Model Adaptation to Different Treatment Planning Practices

This work aims to study the generalizability of a pre-developed deep learning (DL) dose prediction model for volumetric modulated arc therapy (VMAT) for prostate cancer and to adapt the model to three different internal treatment planning styles and one external institution planning style. We built the source model with planning data from 108 patients previously treated with VMAT for prostate cancer. For the transfer learning, we selected patient cases planned with three different styles from the same institution and one style from a different institution to adapt the source model to four target models. We compared the dose distributions predicted by the source model and the target models with the clinical dose predictions and quantified the improvement in the prediction quality for the target models over the source model using the Dice similarity coefficients (DSC) of 10% to 100% isodose volumes and the dose-volume-histogram (DVH) parameters of the planning target volume and the organs-at-risk. The source model accurately predicts dose distributions for plans generated in the same source style but performs sub-optimally for the three internal and one external target styles, with the mean DSC ranging between 0.81-0.94 and 0.82-0.91 for the internal and the external styles, respectively. With transfer learning, the target model predictions improved the mean DSC to 0.88-0.95 and 0.92-0.96 for the internal and the external styles, respectively. Target model predictions significantly improved the accuracy of the DVH parameter predictions to within 1.6%. We demonstrated model generalizability for DL-based dose prediction and the feasibility of using transfer learning to solve this problem. With 14-29 cases per style, we successfully adapted the source model into several different practice styles. This indicates a realistic way to widespread clinical implementation of DL-based dose prediction.

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