The influence of dose constraint point placement on optimized radiation therapy treatment planning

To efficiently use linear and quadratic programming for treatment planning optimization on a routine basis, automated methods are needed for placing dose constraint points. We have investigated, for linear programming optimization, the minimum number of constraint points needed to achieve an acceptable approximation to the desired (ideal) solution. Seven different constraint point placement algorithms were evaluated for a given objective function. One of these algorithms was chosen for routine clinical use at our institution. This algorithm places constraint points on the perimeter of the target volume and on the perimeter and in the interior of each normal structure. Additional points are placed on the perimeter of a constant thickness buffer region surrounding the target volume. Excellent optimization results are obtained with 40-70 constraint points per treatment planning slice.