Adaptive and robust radiation therapy optimization for lung cancer

A previous approach to robust intensity-modulated radiation therapy (IMRT) treatment planning for moving tumors in the lung involves solving a single planning problem before the start of treatment and using the resulting solution in all of the subsequent treatment sessions. In this paper, we develop an adaptive robust optimization approach to IMRT treatment planning for lung cancer, where information gathered in prior treatment sessions is used to update the uncertainty set and guide the reoptimization of the treatment for the next session. Such an approach allows for the estimate of the uncertain effect to improve as the treatment goes on and represents a generalization of existing robust optimization and adaptive radiation therapy methodologies. Our method is computationally tractable, as it involves solving a sequence of linear optimization problems. We present computational results for a lung cancer patient case and show that using our adaptive robust method, it is possible to attain an improvement over the traditional robust approach in both tumor coverage and organ sparing simultaneously. We also prove that under certain conditions our adaptive robust method is asymptotically optimal, which provides insight into the performance observed in our computational study. The essence of our method – solving a sequence of single-stage robust optimization problems, with the uncertainty set updated each time – can potentially be applied to other problems that involve multi-stage decisions to be made under uncertainty.     

A collaboratory for radiation therapy treatment planning optimization research

Intensity modulated radiation therapy treatment planning (IMRTP) is a challenging application of optimization technology. We present software tools to facilitate IMRTP research by computational scientists who may not have convenient access to radiotherapy treatment planning systems. The tools, developed within Matlab and CERR (computational environment for radiotherapy research), allow convenient access, visualization, programmable manipulation, and sharing of patient treatment planning data, as well as convenient generation of dosimetric data needed as input for treatment plan optimization research. CERR/Matlab also provides a common framework for storing, reviewing, sharing, and comparing optimized dose distributions from multiple researchers.     

Dynamic multi-appointment patient scheduling for radiation therapy

Seeking to reduce the potential impact of delays on radiation therapy cancer patients such as psychological distress, deterioration in quality of life and decreased cancer control and survival, and motivated by inefficiencies in the use of expensive resources, we undertook a study of scheduling practices at the British Columbia Cancer Agency (BCCA). As a result, we formulated and solved a discounted infinite-horizon Markov decision process for scheduling cancer treatments in radiation therapy units. The main purpose of this model is to identify good policies for allocating available treatment capacity to incoming demand, while reducing wait times in a cost-effective manner. We use an affine architecture to approximate the value function in our formulation and solve an equivalent linear programming model through column generation to obtain an approximate optimal policy for this problem. The benefits from the proposed method are evaluated by simulating its performance for a practical example based on data provided by the BCCA.     

Mathematical optimization in intensity modulated radiation therapy

The design of an intensity modulated radiotherapy treatment includes the selection of beam angles (geometry problem), the computation of an intensity map for each selected beam angle (intensity problem), and finding a sequence of configurations of a multileaf collimator to deliver the treatment (realization problem). Until the end of the last century research on radiotherapy treatment design has been published almost exclusively in the medical physics literature. However, since then, the attention of researchers in mathematical optimization has been drawn to the area and important progress has been made. In this paper we survey the use of optimization models, methods, and theories in intensity modulated radiotherapy treatment design.     

A stochastic appointment scheduling system on multiple resources with dynamic call-in sequence and patient no-shows for an outpatient clinic

This research focuses on the stochastic assignment system motivated by outpatient clinics, especially the physical therapy in rehabilitation service. The aim of this research is to develop a stochastic overbooking model to enhance the service quality as well as to increase the utilization of multiple resources, like therapy equipment in a physical therapy room, with the consideration of patients’ call-in sequence. The schedule for a single-service period includes a fixed number of blocks of equal length. When patients call, they are assigned to an appointment time for that block, and an existing appointment is not allowed to be changed. In each visit, a patient might require more than one resource and a probability of no-show. Two estimation methods were proposed for the expected waiting and overtime cost with multiple resources: Convolution Estimation Method and Joint Cumulative Estimation Method for the upper and lower bound value; respectively. A numerical example based on a physical therapy room was used to show that this stochastic model was able to schedule patients for better profitability compared with traditional appointment systems based on four prioritization rules. The workload in each appointment slot was more balanced albeit more patients were assigned to the first slot to fill up the empty room.     

A branch-and-price approach for integrating nurse and surgery scheduling

A common problem at hospitals is the extreme variation in daily (even hourly) workload pressure for nurses. The operating room is considered to be the main engine and hence the main generator of variance in the hospital. The purpose of this paper is threefold. First of all, we present a concrete model that integrates both the nurse and the operating room scheduling process. Second, we show how the column generation technique approach, one of the most employed exact methods for solving nurse scheduling problems, can easily cope with this model extension. Third, by means of a large number of computational experiments we provide an idea of the cost saving opportunities and required solution times.     

Scheduling preventive maintenance for modular designed components: A dynamic approach

One of the benefits of modular design is ease-of-service. While modular design helps simplify field maintenance, extensive depot maintenance and spare modules are required to support the field maintenance. This study develops a dynamic approach for scheduling preventive maintenance at a depot with the limited availability of spare modules and other constraints. A backward allocation algorithm is proposed and applied to scheduling the preventive maintenance of an engine module installed in T-59 advanced jet trainers in the Republic of Korea Air Force. The algorithm developed by this study can be used to solve similar problems for various systems such as aerospace vehicles, heavy machinery, and medical equipment. The contribution of this study includes the uniqueness of the algorithm, the flexibility to deal with variables changing over time, and the ability to incorporate additional variables to handle complex situations.     

Multi-objective optimisation of positively homogeneous functions and an application in radiation therapy

Unconstrained multi-objective optimisation problems with p$p$ positively homogeneous objective functions are considered. We prove that such problems reduce to multi-objective optimisation problems with p−1$p-1$ objectives and a single equality constraint. Thus, problems with two objectives can be solved with standard single objective optimisation methods and, for problems with p>2$p>2$ objectives, we can compute infinitely many efficient solutions by solving a finite number of single objective problems. The proposed procedure is applied on radiotherapy for cancer treatment.     

Approximate dynamic programming algorithms for optimal dosage decisions in controlled ovarian hyperstimulation

In the controlled ovarian hyperstimulation (COH) treatment, clinicians monitor the patients’ physiological responses to gonadotropin administration to tradeoff between pregnancy probability and ovarian hyperstimulation syndrome (OHSS). We formulate the dosage control problem in the COH treatment as a stochastic dynamic program and design approximate dynamic programming (ADP) algorithms to overcome the well-known curses of dimensionality in Markov decision processes (MDP). Our numerical experiments indicate that the piecewise linear (PWL) approximation ADP algorithms can obtain policies that are very close to the one obtained by the MDP benchmark with significantly less solution time.     

Solving the dynamic ambulance relocation and dispatching problem using approximate dynamic programming

Emergency service providers are supposed to locate ambulances such that in case of emergency patients can be reached in a time-efficient manner. Two fundamental decisions and choices need to be made real-time. First of all immediately after a request emerges an appropriate vehicle needs to be dispatched and send to the requests’ site. After having served a request the vehicle needs to be relocated to its next waiting location. We are going to propose a model and solve the underlying optimization problem using approximate dynamic programming (ADP), an emerging and powerful tool for solving stochastic and dynamic problems typically arising in the field of operations research. Empirical tests based on real data from the city of Vienna indicate that by deviating from the classical dispatching rules the average response time can be decreased from 4.60 to 4.01 minutes, which corresponds to an improvement of 12.89%. Furthermore we are going to show that it is essential to consider time-dependent information such as travel times and changes with respect to the request volume explicitly. Ignoring the current time and its consequences thereafter during the stage of modeling and optimization leads to suboptimal decisions.     

A robust-CVaR optimization approach with application to breast cancer therapy

We present a framework to optimize the conditional value-at-risk (CVaR) of a loss distribution under uncertainty. Our model assumes that the loss distribution is dependent on the state of some system and the fraction of time spent in each state is uncertain. We develop and compare two robust-CVaR formulations that take into account this type of uncertainty. We motivate and demonstrate our approach using radiation therapy treatment planning of breast cancer, where the uncertainty is in the patient’s breathing motion and the states of the system are the phases of the patient’s breathing cycle. We use a CVaR representation of the tails of the dose distribution to the points in the body and account for uncertainty in the patient’s breathing pattern that affects the overall dose distribution.     

Implementation of dynamic programming for chaos control in discrete systems

In this paper the control of discrete chaotic systems by designing linear feedback controllers is presented. The linear feedback control problem for nonlinear systems has been formulated under the viewpoint of dynamic programming. For suppressing chaos with minimum control effort, the system is stabilized on its first order unstable fixed point (UFP). The presented method also could be employed to make any desired nth order fixed point of the system, stable. Two different methods for higher order UFPs stabilization are suggested. Afterwards, these methods are applied to two well-known chaotic discrete systems: the Logistic and the Henon Maps. For each of them, the first and second UFPs in their chaotic regions are stabilized and simulation results are provided for the demonstration of performance.     

Pinning consensus control for switched multi-agent systems: A switched adaptive dynamic programming method

Stability is fundamental to ensure the operation of control system, but optimality is the ultimate goal to achieve the maximum performance. This paper investigates an event-triggered pinning optimal consensus control for switched multi-agent system (SMAS) via a switched adaptive dynamic programming (ADP) method. The technical contribution mainly lies in two aspects. On the one hand, in order to optimize the control performance and ensure the consensus, the switched local value function (SLVF) and the minimum-error switching law are constructed. Based on SLVF, an algorithm of switched ADP policy iteration is proposed, and its convergence and optimality are proved. On the other hand, considering that it is impractical to install a controller for each agent in reality, a pinning strategy is developed to guide the setting of the ADP controller, which can reduce the waste of control resources. A new condition is constructed to determine the minimum number of controlled vertices of the SMAS. Lastly, a numerical example is given to verify the effectiveness of the proposed method.     

A shift scheduling model for employees with different seniority levels and an application in healthcare

This paper addresses the problem of scheduling medical residents that arises in different clinical settings of a hospital. The residents are grouped according to different seniority levels that are specified by the number of years spent in residency training. It is required from the residents to participate in the delivery of patient care services directly by working weekday and weekend day shifts in addition to their regular daytime work. A monthly shift schedule is prepared to determine the shift duties of each resident considering shift coverage requirements, seniority-based workload rules, and resident work preferences. Due to the large number of constraints often conflicting, a multi-objective programming model has been proposed to automate the schedule generation process. The model is implemented on a real case in the pulmonary unit of a local hospital for a 6-month period using sequential and weighted methods. The results indicate that high quality solutions can be obtained within a few seconds compared to the manually prepared schedules expending considerable effort and time. It is also shown that the employed weighting procedure based on seniority levels performs much better compared to the preemptive method in terms of computational burden.     

Approximate dynamic programming for stochastic linear control problems on compact state spaces

This paper addresses Markov Decision Processes over compact state and action spaces. We investigate the special case of linear dynamics and piecewise-linear and convex immediate costs for the average cost criterion. This model is very general and covers many interesting examples, for instance in inventory management. Due to the curse of dimensionality, the problem is intractable and optimal policies usually cannot be computed, not even for instances of moderate size.     

Neighborhood search approaches to beam orientation optimization in intensity modulated radiation therapy treatment planning

The intensity modulated radiation therapy (IMRT) treatment planning problem consists of several subproblems which are typically solved sequentially. We seek to combine two of the subproblems: the beam orientation optimization (BOO) problem and the fluence map optimization (FMO) problem. The BOO problem is the problem of selecting the beam orientations to deliver radiation to the patient. The FMO problem is the problem of determining the amount of radiation intensity, or fluence, of each beamlet in each beam. The solution to the FMO problem measures the quality of a beam set, but the majority of previous BOO studies rely on heuristics and approximations to gauge the quality of the beam set. In contrast with these studies, we use an exact measure of the treatment plan quality attainable using a given beam set, which ensures convergence to a global optimum in the case of our simulated annealing algorithm and a local optimum in the case of our local search algorithm. We have also developed a new neighborhood structure that allows for faster convergence using our simulated annealing and local search algorithms, thus reducing the amount of time required to obtain a good solution. Finally, we show empirically that we can generate clinically acceptable treatment plans that require fewer beams than in current practice. This may reduce the length of treatment time, which is an important clinical consideration in IMRT.     

A multi-objective multi-period stochastic programming model for public debt management

While raising debt on behalf of the government, public debt managers need to consider several possibly conflicting objectives and have to find an appropriate combination for government debt taking into account the uncertainty with regard to the future state of the economy. In this paper, we explicitly consider the underlying uncertainties with a complex multi-period stochastic programming model that captures the trade-offs between the objectives. The model is designed to aid the decision makers in formulating the debt issuance strategy. We apply an interactive procedure that guides the issuer to identify good strategies and demonstrate this approach for the public debt management problem of Turkey.     

Mid-term and short-term planning support for home health care services

In this paper we are looking at routing and scheduling problems arising in the context of home health care services. Many small companies are working in this sector in Germany and planning is still done manually, resulting in long planning times and relatively inflexible solutions.     

A stochastic programming model for scheduling call centers with global Service Level Agreements

We consider the issue of call center scheduling in an environment where arrivals rates are highly variable, aggregate volumes are uncertain, and the call center is subject to a global service level constraint. This paper is motivated by work with a provider of outsourced technical support services where call volumes exhibit significant variability and uncertainty. The outsourcing contract specifies a Service Level Agreement that must be satisfied over an extended period of a week or month. We formulate the problem as a mixed-integer stochastic program. Our model has two distinctive features. Firstly, we combine the server sizing and staff scheduling steps into a single optimization program. Secondly, we explicitly recognize the uncertainty in period-by-period arrival rates. We show that the stochastic formulation, in general, calculates a higher cost optimal schedule than a model which ignores variability, but that the expected cost of this schedule is lower. We conduct extensive experimentation to compare the solutions of the stochastic program with the deterministic programs, based on mean valued arrivals. We find that, in general, the stochastic model provides a significant reduction in the expected cost of operation. The stochastic model also allows the manager to make informed risk management decisions by evaluating the probability that the Service Level Agreement will be achieved.