A reinforcement learning application of a guided Monte Carlo Tree Search algorithm for beam orientation selection in radiation therapy.

Current beam orientation optimization algorithms for radiotherapy, such as column generation (CG), are typically heuristic or greedy in nature because of the size of the combinatorial problem, which leads to suboptimal solutions. We propose a reinforcement learning strategy using Monte Carlo Tree Search that can find a better beam orientation set in less time than CG. We utilize a reinforcement learning structure involving a supervised learning network to guide the Monte Carlo Tree Search and to explore the decision space of beam orientation selection problems. We previously trained a deep neural network (DNN) that takes in the patient anatomy, organ weights, and current beams, then approximates beam fitness values to indicate the next best beam to add. Here, we use this DNN to probabilistically guide the traversal of the branches of the Monte Carlo decision tree to add a new beam to the plan. To assess the feasibility of the algorithm, we used a test set of 13 prostate cancer patients, distinct from the 57 patients originally used to train and validate the DNN, to solve for 5-beam plans. To show the strength of the guided Monte Carlo tree search (GTS) compared to other search methods, we also provided the performances of guided search, uniform tree search and random search algorithms. On average, GTS outperformed all other methods. It found a better solution than CG in 237 seconds on average, compared to 360 seconds for CG, and outperformed all other methods in finding a solution with a lower objective function value in less than 1000 seconds. Using our guided tree search (GTS) method, we could maintain planning target volume (PTV) coverage within 1% error similar to CG, while reducing the organ-at-risk (OAR) mean dose for body, rectum, left and right femoral heads; mean dose to bladder was 1% higher with GTS than with CG.