  Currently in HDR brachytherapy planning, a manual fine-tuning of an objective
function is necessary to obtain case-specific valid plans. This study intends
to facilitate this process by proposing a patient-specific inverse planning
algorithm for HDR prostate brachytherapy: GPU-based multi-criteria optimization
(gMCO).
  Two GPU-based optimization engines including simulated annealing (gSA) and a
quasi-Newton optimizer (gL-BFGS) were implemented to compute multiple plans in
parallel. After evaluating the equivalence and the computation performance of
these two optimization engines, one preferred optimization engine was selected
for the gMCO algorithm. Five hundred sixty-two previously treated prostate HDR
cases were divided into validation set (100) and test set (462). In the
validation set, the number of Pareto optimal plans to achieve the best plan
quality was determined for the gMCO algorithm. In the test set, gMCO plans were
compared with the physician-approved clinical plans.
  Over 462 cases, the number of clinically valid plans was 428 (92.6%) for
clinical plans and 461 (99.8%) for gMCO plans. The number of valid plans with
target V100 coverage greater than 95% was 288 (62.3%) for clinical plans and
414 (89.6%) for gMCO plans. The mean planning time was 9.4 s for the gMCO
algorithm to generate 1000 Pareto optimal plans.
  In conclusion, gL-BFGS is able to compute thousands of SA equivalent
treatment plans within a short time frame. Powered by gL-BFGS, an ultra-fast
and robust multi-criteria optimization algorithm was implemented for HDR
prostate brachytherapy. A large-scale comparison against physician approved
clinical plans showed that treatment plan quality could be improved and
planning time could be significantly reduced with the proposed gMCO algorithm.
