TU-C-17A-01: A Data-Based Development for Pratical Pareto Optimality Assessment and Identification

Purpose: To develop an efficient Pareto optimality assessment scheme to support plan comparison and practical determination of best-achievable practical treatment plan goals. Methods: Pareto efficiency reflects the tradeoffs among competing target coverage and normal tissue sparing in multi-criterion optimization (MCO) based treatment planning. Assessing and understanding Pareto optimality provides insightful guidance for future planning. However, current MCO-driven Pareto estimation makes relaxed assumptions about the Pareto structure and insufficiently account for practical limitations in beam complexity, leading to performance upper bounds that may be unachievable. This work proposed an alternative data-driven approach that implicitly incorporates the practical limitations, and identifies the Pareto frontier subset by eliminating dominated plans incrementally using the Edgeworth Pareto hull (EPH). The exactness of this elimination process also permits the development of a hierarchical procedure for speedup when the plan cohort size is large, by partitioning the cohort and performing elimination in each subset before a final aggregated elimination. The developed algorithm was first tested on 2D and 3D where accuracy can be reliably assessed. As a specific application, the algorithm was applied to compare systematic plan quality for lower head-and-neck, amongst 4 competing treatment modalities. Results: The algorithm agrees exactly with brute-force pairwise comparison and visual inspection in low dimensions. The hierarchical algorithm shows sqrt(k) folds speedup with k being the number of data points in the plan cohort, demonstrating good efficiency enhancement for heavy testing tasks. Application to plan performance comparison showed superiority of tomotherapy plans for the lower head-and-neck, and revealed a potential nonconvex Pareto frontier structure. Conclusion: An accurate and efficient scheme to identify Pareto frontier from a plan cohort has been developed. This implementation would guide generating good yet practically achievable plan quality goals for further planning. The observation of a systematic performance bias and a nonconvex Pareto frontier warrants further investigation