For intermediate and high risk prostate cancer, both the prostate gland and seminal vesicles are included in the clinical target volume. Internal motion patterns of these two organs vary, presenting a challenge for adaptive treatment. Adaptive techniques such as isocenter repositioning and soft tissue alignment are effective when tumor volumes only exhibit translational shift, while direct re-optimization of the intensity-modulated radiation therapy (IMRT) plan maybe more desirable when extreme deformation or differential positioning changes of the organs occur. Currently, direct re-optimization of the IMRT plan using beamlet (or fluence map) has not been reported. In this study, we report a novel on-line re-optimization technique that can accomplish plan adjustment on-line. Deformable image registration is used to provide position variation information on each voxel along the three dimensions. The original planned dose distribution is used as the 'goal' dose distribution for adaptation and to ensure planning quality. Fluence maps are re-optimized via linear programming, and a plan solution can be achieved within 2 min. The feasibility of this technique is demonstrated with a clinical case with large deformation. Such on-line ART process can be highly valuable with hypo-fractionated prostate IMRT treatment.
Many multiple criteria decision making methods have been proposed and applied to water planning. Their purpose is to provide information on tradeoffs among objectives and to help users articulate value judgments in a systematic, coherent, and documentable manner. The wide variety of available techniques confuses potential users, causing inappropriate matching of methods with problems. Experiments in which water planners apply more than one multicriteria procedure to realistic problems can help dispel this confusion by testing method appropriateness, ease of use, and validity. We summarize one such experiment where U.S. Army Corps of Engineers personnel used several methods to screen urban water supply plans. The methods evaluated include goal programming, ELECTRE I, additive value functions, multiplicative utility functions, and three techniques for choosing weights (direct rating, indifference tradeoff, and the analytical hierarchy process). Among the conclusions we reach are the following. First, experienced planners generally prefer simpler, more transparent methods. Additive value functions are favored. Yet none of the methods are endorsed by a majority of the participants; many preferred to use no formal method at all. Second, there is strong evidence that rating, the most commonly applied weight selection method, is likely to lead to weights that fail to represent the trade‐offs that users are willing to make among criteria. Finally, we show that decisions can be as or more sensitive to the method used as to which person applies it. Therefore, if who chooses is important, then so too is how a choice is made.
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