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However, the current practice of pre\u2010operative planning requires manual needle paths design, which is highly dependent on operator experience and may lead to unnecessary insertion trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To address this issue, this study introduces and validates an automated integrated optimization method for needle paths and dwell times for an institutional protocol of 3D\u2010PIT based ISBT for locally recurrent cervical cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Materials<\/jats:title>\n                    <jats:p>\n                      To automatically generate a treatment plan, a candidate needle path set was first generated based on patient's anatomy and the transvaginal template. Then, a two\u2010layer optimization strategy was introduced for automated integrated optimization of the needle paths and dwell times, with the outer layer employing simulated annealing to optimize the needle paths, and the inner layer to optimize the dwell times. A total of 40 patient cases (with the prescribed dose to HR\u2010CTV D\n                      <jats:sub>90%<\/jats:sub>\n                      being 6 Gy (physical dose) per fraction, and 2\u20138 fractions per case, totaling 219 independent fraction plans) with locally recurrent cervical cancer previously treated with 3D\u2010PIT\u2010assisted ISBT were enrolled in this study. Automatic plans for all fractions were generated and evaluated using the same number of needles as in the clinical plans, with the dosimetric results of the clinical plans used as constraints. In addition, the quality of automatic plans using fewer needles was also investigated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The method generated clinically\u00a0acceptable plans in 1.5\u00a0\u00b1\u00a01.2 min, requiring 145\u00a0\u00b1\u00a074 iterations, according to institutional protocols based on the EMBRACE II. In terms of dosimetric quality, the automatic plans met the constraints and generally outperformed the clinical plans in protecting organs\u2010at\u2010risk (OARs). When normalizing both plans to the same HR\u2010CTV D\n                      <jats:sub>90%<\/jats:sub>\n                      and comparing the dosimetric outcomes of OARs, the D\n                      <jats:sub>2cc<\/jats:sub>\n                      of rectum, bladder, colon, and small intestine were reduced from 363 to 350 cGy, 397 to 376 cGy, 226 to 204 cGy, and 140 to 123 cGy, respectively (all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). The D\n                      <jats:sub>0.1cc<\/jats:sub>\n                      of urethra was reduced from 406 to 351 cGy (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). V\n                      <jats:sub>100%<\/jats:sub>\n                      of HR\u2010CTV remained the same at 78% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.28), and V\n                      <jats:sub>150%<\/jats:sub>\n                      of HR\u2010CTV was increased from 42% to 44% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). Total dwell time decreased from 278 to 271 seconds (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). In addition, plans with fewer needles generally had higher doses to OARs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The automated integrated optimization method provides a fast, standardized pre\u2010planning tool for 3D\u2010PIT\u2010assisted ISBT. By reducing operator dependence, it serves as a valuable clinical baseline to help determine optimal needle configurations and maintain consistent dosimetric quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mp.70411","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T01:26:31Z","timestamp":1774920391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Integrated optimization of needle paths and dwell time for individualized template\u2010guided interstitial brachytherapy"],"prefix":"10.1002","volume":"53","author":[{"given":"Qinglong","family":"Yao","sequence":"first","affiliation":[{"name":"Image Processing Center Beihang University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiyue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peking University Third Hospital  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Liu","sequence":"additional","affiliation":[{"name":"Image Processing Center Beihang University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peking University Third Hospital  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fugen","family":"Zhou","sequence":"additional","affiliation":[{"name":"Image Processing Center Beihang University  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Peking University Third Hospital  Beijing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuwen","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"1","key":"e_1_2_9_2_1","first-page":"10","article-title":"Trends of cervical cancer at global, regional, and national level: data from the Global Burden of Disease study 2019","volume":"21","author":"Zhang XX","year":"2021","journal-title":"BMC Public 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