{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T18:02:52Z","timestamp":1784743372117,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["RGPIN\u20102016\u201003870"],"award-info":[{"award-number":["RGPIN\u20102016\u201003870"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","award":["RGPIN\u201005625\u20102019"],"award-info":[{"award-number":["RGPIN\u201005625\u20102019"]}],"id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Robust optimization (RO) has been proposed to mitigate breathing motion uncertainty during treatment in intensity\u2010modulated radiation therapy (IMRT) planning for breast or lung cancer. RO is a pessimistic approach that implicitly trades off average\u2010case for worst\u2010case treatment plan quality. Pareto robust optimization (PRO) provides a mechanism for improving nonworst\u2010case plan outcomes, but often remains overly conservative in the average\u00a0case.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The goal of this study is to characterize the trade\u2010off between the optimality of robust IMRT plans in the worst case and the treatment quality in nonworst\u2010case realizations of breathing motion. We provide a light Pareto robust optimization (LPRO) method for IMRT and test its clinical viability for improving the average\u2010case plan quality while preserving robustness, in comparison to RO and PRO plans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Five clinical left\u2010sided breast cancer patients were included in the study, each with an associated 4D\u2010CT dataset approximating their breathing cycle. Using simulation, 50 different breathing patterns were generated for each patient. A first\u2010stage optimization was solved with the objective of cardiac sparing while ensuring robustness on the target dose under breathing uncertainty. Next, a second\u2010stage objective of overdose minimization was considered to improve plan quality in a controlled LPRO framework. For the simulated breathing scenarios, the trade\u2010off between loss of average cardiac sparing at worst\u2010case and the overdose to the breast was quantified by calculating the accumulated dose for each plan in each breathing scenario. Finally, the RO, PRO, and LPRO plans were each evaluated using eight clinical dose\u2013volume criteria on the target and organs at\u00a0risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The LPRO models allowed for significantly sharper dose falloffs in the expected dose instances, relative to both RO and PRO models. Plans began looking valid for delivery with average allowances of as little as +0.1\u00a0Gy additional dose to the heart, and most patients experienced diminishing returns beyond +0.2\u00a0Gy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Without sacrificing robustness, the LPRO approach produces viable plans with true total\u2010target irradiation. Furthermore, the plans produced were able to reduce the nonworst\u2010case downside typical of RO, without the characteristic overdosing or average\u2010case pessimism seen in prior models.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.16298","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T09:54:11Z","timestamp":1676368451000},"page":"2637-2648","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Light Pareto robust optimization for IMRT treatment planning"],"prefix":"10.1002","volume":"50","author":[{"given":"Danielle A.","family":"Ripsman","sequence":"first","affiliation":[{"name":"Department of Management Sciences University of Waterloo Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahimeh","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Department of Management Sciences University of Waterloo Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossein","family":"Abouee\u2010Mehrizi","sequence":"additional","affiliation":[{"name":"Department of Management Sciences University of Waterloo Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houra","family":"Mahmoudzadeh","sequence":"additional","affiliation":[{"name":"Department of Management Sciences University of Waterloo Waterloo Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,2,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.08.019"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11081-005-2066-2"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4875700"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/50\/23\/003"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/51\/10\/014"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.07.018"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4916092"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2017.10.021"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.01.046"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmp.2021.02.026"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/44\/12\/308"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1287\/opre.1070.0484"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1088\/1361-6560\/aae659"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1287\/opre.21.5.1154"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/51\/21\/016"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejor.2014.04.038"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.orhc.2015.03.003"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1287\/ijoc.2022.1167"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1287\/mnsc.2013.1753"},{"key":"e_1_2_8_21_1","volume-title":"Reducing Conservatism in Pareto Robust Optimization","author":"Fahimeh R","year":"2022"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-05465-5_3"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejor.2011.11.003"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00186-014-0474-9"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.11.016"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.06.056"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4894702"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/1533033818816072"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(98)00130-8"},{"key":"e_1_2_8_30_1","volume-title":"V12.7: Users Manual for CPLEX","author":"Cplex II","year":"2017"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eswa.2015.06.028"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.omega.2017.12.005"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1088\/0031-9155\/58\/3\/621"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.4908224"},{"key":"e_1_2_8_35_1","unstructured":"MATLAB Version 9.12.0 (R2022a).The MathWorks Inc;2022."}],"container-title":["Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.16298","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mp.16298","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mp.16298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T11:41:06Z","timestamp":1692531666000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/mp.16298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,24]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1002\/mp.16298"],"URL":"https:\/\/doi.org\/10.1002\/mp.16298","archive":["Portico"],"relation":{},"ISSN":["0094-2405","2473-4209"],"issn-type":[{"value":"0094-2405","type":"print"},{"value":"2473-4209","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,24]]},"assertion":[{"value":"2022-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}