MCO PLANNING OF TREATMENTS WITH AVAILABLE TECHNOLOGIES IN RADIOTHERAPY (RT)

Description

[0001] This disclosure (and claims) relates to a multi-criteria optimization (MCO) method.

[0002] A cancer patient is to receive radiation therapy (radiotherapy - RT). A minimum dose is prescribed for the tumor tissue, and maximum doses for surrounding healthy tissue structures are prescribed, which ideally should not be exceeded. In principle, several technical options (technologies) are available for such a patient to receive this treatment.

[0003] Examples include: 1. Protons 2. Photons via rotation therapy with 1 rotation 3. Photons via rotation therapy with 2 rotations 4. Photons via IMRT with 9 fields (with 9 fixed angles) 5. Photons via IMRT with 9 fields (with angles other than in option 4) 6. Modern devices of new technology 7. Technically older therapy devices that have been in use for a longer time.

[0004] Each of these technologies can be implemented on one or more different therapy devices. Each device requires a different response and specific planning, although the individual treatment goals remain the same across all technologies used. In this context, reference is made to the technical teaching disclosed in document US 2013 / 090549 A1.

[0005] From the clinic's perspective, the planning of all treatment cases (overall planning) is relevant, taking into account all available therapy equipment. The overall plan should not only address individual medical aspects of the therapy but also simultaneously schedule the treatments.

[0006] Mathematically, this results in a multi-criteria planning problem with the following goals: high probability of therapeutic success while simultaneously avoiding side effects in each individual therapy and the most effective possible use of the available therapy devices, with which as many patients as possible can receive therapy without having to accept long waiting times (Time to Treatment).

[0007] The current state of the art involves a two-stage decision-making approach. First, the technology is selected, then this technology is planned. Multi-criteria planning methods can be used in the second stage. Physicians make the decision regarding the technology selection based on experience and the results of clinical studies. To determine which technology is best suited for a given case, a separate plan must be developed for each possible technology, the respective plans compared, and then the "best" one selected.

[0008] The clinical workflow must also be considered: In urgent cases, treatments already scheduled for specific devices may have to be postponed or even rescheduled for other devices. Or the patient urgently needing therapy may have to wait.

[0009] Each technology requires specific, dedicated equipment – ​​proton therapy cannot be performed with a photon accelerator. The number of available treatment devices is one of the limiting factors for hospitals. Treating more patients – especially since proton therapy facilities are very limited in availability due to their cost and complexity – necessitates waiting times or treatment rescheduling. This reveals a multi-criteria optimization problem: treating as many patients as possible within a given timeframe – or with a given, usually limited, investment capital.

[0010] If a hospital has at least two devices suitable for treatment, it can plan, purely from an organizational standpoint (via scheduling), which (daily) fractions of a patient's fractionated treatment should be performed on which of the radiation devices mentioned in the example. If one of the devices is already occupied by another patient for a certain period, it cannot be included in the planning for the new patient. The patient must either experience a significant waiting time or be turned away. Especially in the treatment of malignant tumors, it is particularly undesirable to make patients wait or even turn them away due to occupied devices. It is crucial here to begin the treatment scheduled for the fractionation period as quickly as possible. A malignant tumor, for example, is not something that allows for a long delay.These patients in particular are considered high-risk patients, with the risk being the time it takes to start treatment.

[0011] Another difficulty lies in using both newly manufactured and older radiation therapy devices. It turns out that the modern, recently acquired devices are constantly under strain or fully utilized, and there are few, if any, patients willing to be treated with the older devices or prescribed treatment using them.

[0012] The technical problem of the invention lies in being able to provide each patient with good therapy individually, whereby the quality of the therapy also includes minimizing the waiting time of each patient (under "time to treatment" a technical criterion of therapy planning).

[0013] The invention is based on the understanding that a planned total dose of a therapy is distributed across several treatment sessions, with the fractions originating from different radiation devices. It assumes the use of two different radiation devices, resulting in daily doses being delivered by one device and other daily doses by a different device. Considering the entire therapy, this creates a combinatorial effect due to the sum of the daily doses over the course of the therapy. When referring to a "mixed technology," "mixed therapy," or "combined radiation delivery," it means that a certain number of (daily) fractions of the planned therapy (with a total number of fractions) are administered by one device, and the remaining number of (daily) fractions by another. However, this all occurs within the planning of the therapy, not the therapy itself.These references generally relate to the planning.

[0014] If two radiation devices, therapy device A and therapy device B, are used, this solution offers two options: one where only therapy device A emits its radiation to the patient, which would be pure A treatment; and another where only therapy device B emits its radiation to the patient, which would be B treatment.

[0015] Any other type of combined radiation delivery from both devices to the same patient during the course of therapy is a combination therapy, the effect of which lies between "A only" and "B only". This discussion focuses on the planning of these therapies, not their actual application.

[0016] Reference is made to the claims, which are included here to solve the aforementioned problem, in particular independent claims 1 and 7.

[0017] Exemplary embodiments of the invention are explained in more detail with the aid of the figures. All explanations are equally relevant to the disclosure, but they are not to be interpreted as requiring their inclusion as necessary components of the claims. All subsequent examples remain examples even if they are not explicitly preceded by the word "by way of example". Figure 1 is a schematic view of an example of a procedure for planning a therapy. Here, patches 401 and 201 represent the technologies on a display device with display 10 (represented by the four dashed corners) and two operating aids 21 and 22 as sliders, each with a handle 21a and 21b (represented as a graphically depicted control button). Patch 101 is referred to as patch 201 in the following Figure 1Awith its support points, which here apply to Patch 101. Patch 201 corresponds to Patch 101. Figure 1A helps in understanding the Pareto front, using the example of a Pareto front 201. A large number of support points 2011 to 20110 are recognizable. This can be transferred to the Pareto front 101 of the Figure 1 , applicable there as corresponding support points 101 1 to 101 10. Front 101 is therefore by no means continuous, but only functionally connected; hence it is in Figure 1Additionally shown as a (thin) line, which is essentially not one. The Pareto front can also be conceived as a projection onto n-dimensional space, in which space it exists, although graphically it can only be represented as a projection. Figures 2A to 2D show various radiation devices 100, 200, and 300, 300', which provide different radiation devices (or "technologies"). These include modern devices of new technology and devices that have been in use for some time. It can be further specified that... Figures 2C and 2D There is a device A of technology 300, and another device B of technology 300, which is older and therefore less likely to be chosen by the treating physician for their planning, unless other criteria play a role, e.g., immediate availability of the radiation device to first use the radiation device for treatment. Figure 2Dto begin planning (and thus prepare for later therapy). This occurs when radiation machine A is occupied and therefore unavailable. The older technology radiation machine 300' in Figure 2D It is to be interpreted as a "different technology", although it would technically be the same technology as the modern radiation device of the Figure 2C Using technology 300, Figures 4A to 4D illustrate how a field F is created or defined, which maps all combinations of achievable mixing ratios of two technologies with Pareto fronts 601 and 701, given the target criteria c1 and c2. Figure 4E illustrates an alternative formation of the field F, using the same points on the Pareto fronts as in Figure 4BFigures 5A and 5B show a limitation of achievable values ​​in the target criteria c1 and c2 by the intervals I1 and I2 (also called the therapeutic window f), which restricts the range of achievable mixing ratios of technologies, represented here as the restricted field F'. Figure 6 shows a further restriction of the field F', resulting in the fields F1" and F2". This further limitation results from setting a predefined minimum (or maximum) proportion of fractionations per technology. The criterion "at least a 2 / 3 proportion of technology 601" (or at most a 1 / 3 proportion of technology 701) is depicted. Figure 7 shows the field F' in the case where one technology is strictly better than another technology. Figure 8 shows the field F' in the case where a gap 1401 exists in the value range of one of the target criteria for two selected technologies.Figure 9 shows the field F', here consisting of F1' and F2', for the case where synergy effects result from the combination of two technologies. The field F' is extended. Figure 10 shows the Pareto fronts (with their invisible support points, which are interpolated between them, see also...). Figure 1A The shapes of Pareto fronts 601 to 1201 are recognizable from the Figures 4A to 9The point z k3 currently selected via the sliders is determined by sliders 21a and 22a in control area 2 of the display, where 1 forms the functionally separate patch area of ​​the Pareto fronts. Figures 11A / 11B illustrate the temporal availability of therapy devices A and B (referred to as the "T-devices") in a daily grid of availability (light indicates free, hatched indicates occupied). Figure 12 illustrates a technical-functional data system with a computer, storage system, and the input / output device with a display 10. The display 10 can be a standard display or a touchscreen, allowing navigational control of the planning system with a finger (as a pointing device) instead of a mouse pointer.

[0018] The description addresses the fact that not just one therapy device (such as a radiation device) is available, but several. Naturally, these therapy devices are booked up, meaning they are already reserved for existing therapies within a time slot. Therefore, a new patient requiring therapy must fit into this existing booking system.

[0019] It leads to frustration and even fear when a patient with critically ill cancer cannot be seen immediately, meaning no treatment slot is available and no treatment plan can be developed for them. In other words, no radiation therapy machine is available the moment the patient requests treatment or is assigned a slot by the scheduler.

[0020] One way to make this earliest possible treatment available through its underlying planning is to integrate a different radiation device, or a radiation device of a different technology, or even an older technology, into the therapy plan. This results in a mixture of several daily doses from different radiation devices.

[0021] The "mixing" here should not be understood as mixing the radiation devices, but rather as mixing the effects of the radiation devices on the patient requiring therapy (or summing them with daily doses over the course of the therapy).

[0022] It should be reiterated that no therapy is performed on humans (the patients), but only planned. This planning can be implemented as therapy using the radiation devices outside the scope of the patent claims, but not within the scope of the patent claims. Nevertheless, it sometimes happens that radiation therapy itself is mentioned when describing the planning process.

[0023] In the following, radiation therapy device A and radiation therapy device B, represented by their Pareto functions 601 and 701 as shown in the figures, will be considered as at least two radiation therapy devices whose effects are assumed to jointly affect the patient requiring therapy during the planning phase (for the duration of the fractionated therapy). Several such radiation therapy devices are possible and can be integrated into the planning.

[0024] To make this possible, the mixture is prepared in fractionated daily doses. The entire treatment duration is considered the timeframe, and the smallest unit of the mixture is one day. This division of units—total duration and, more specifically, the day—is intended as an example. It is based on the currently common fractionated treatment plan for a patient, where one day has proven to be a suitable unit in which the patient can tolerate exertion, recover, and regain their capacity for exertion.

[0025] Therapy planning begins on day 1 and ends after the treatment duration on day X, where X is specified as 30 in the examples.

[0026] After one day Y < X, the planning switches to a different radiation device. The process begins with the first radiation device.

[0027] For the first device, the guiding principle should be "planned therapy start as early as possible." This ensures that the patient in need of treatment experiences no noticeable waiting time and feels they can begin treatment immediately. Often, the technically best radiation therapy device, or the one with the most advanced technology, is not immediately available, making the waiting time disruptive, unpleasant, or even frightening for the patient. Offering therapy that begins immediately is therefore preferred, and even if the immediately available device is not state-of-the-art or doesn't offer the most advanced technology, it should still be scheduled for the initial appointment. While a schedule could be used as a starting point, since treatment quality also plays a role, a simple schedule is insufficient.

[0028] A second premise, though not a mandatory one, is the reduction of the number of changes between radiation devices. Patients find it unpleasant to have to change devices multiple times according to the treatment plan, meaning the plan is designed to incorporate knowledge of device availability. On the other hand, the treatment is divided into daily doses, and a patient may not remember precisely which device they used the previous day to receive their fractionated daily dose.

[0029] The decisive factor is the dose distribution in the relevant voxels of the tissue, over the entire period of the planned therapy, described here as the therapy to be planned, since only this planning is described here and is also subject to the claims, not the radiotherapy performed on the patient itself.

[0030] The criteria (ci) according to which a therapy is planned are technical in nature, selected, for example, from the following: "mean dose in the heart," specific clinical goals, dose at the target, or duration. The technical question that arises is, "what quality of treatment is possible," given the premise of "the earliest possible start." Mathematically, this is a mixed-integer, non-convex problem that only works with the non-dominant points (a point on the Pareto front corresponds to a plan with its technical parameters).

[0031] The premise of planned time to treatment (TTT) sets the framework for the mixing ratio for the overall duration of the therapy planning.

[0032] If multiple changes are made between the radiation devices, this also refers to planned changes, which has a limiting effect on the mixing ratio resulting over the entire duration.

[0033] The quantity F of the efficient mixtures is considered within the limits of what is tolerated. There is an upper limit and a lower limit that defines a minimum radiation dose. This establishes a therapeutic window, which is denoted by f in the figures, e.g. Figure 4E The therapeutic window can change dynamically or vary in size.

[0034] The enlarged image shows Figure 1In the upper right corner is a control area 2, and to the left, occupying a larger area than control area 2, is a patch area 1. Control area 2 lies outside patch area 1, indicating that these two do not functionally overlap. They appear visibly separate to the planner, their positions only being apparent in this example. Figure 1 The layout is configured so that the patch area is located in the lower left and the control area in the upper right (on the visible area of ​​display 10). Other layouts are also possible.

[0035] Control area 2 and patch area 1 are functionally linked. This functional linkage will be explained.

[0036] Patch area 1 shows several Pareto fronts; in the example, these are Pareto fronts 101 and 401, as well as 601, 701, and others in the Figures 4A to Figure 10 .

[0037] Also shown in patch area 1 are two axes c1 and c2 (criterion 1 and criterion 2), which are perpendicular to each other and represent two criteria c1 and c2. Criterion 1 (also c1) and criterion 2 (also c2) are displayed, visible in control area 2 and navigable by the planner. The limitation of the display to two criteria here is only an example; many more criteria will be considered. Examples of possible technical criteria are mentioned above. However, since only three criteria can be displayed in a representable Cartesian space, not n criteria with n greater than 3, this example will be used as a guide, along with the statement that n criteria are considered, i.e., c1 to cn. The representation can also be a projection from n-dimensional space.

[0038] To understand the Pareto front(s), the following should be noted. Each Pareto front is a functionally connected function. Each of these has a multitude of support points (here 101 i instead of the one in Figure 1A (201 i shown). The front is therefore by no means to be understood as continuous, but only "functionally coherent", hence in the Figure 1 A line is also shown at the support points, which essentially does not represent a continuous Pareto front. It could just as easily be a projection from the n-dimensional space in which it exists, although graphically it can only be represented as a projection. The lines represent the functionally connected Pareto fronts. With reference to Figure 1A The magnification makes this clearer; interpolation takes place between the support points.

[0039] The first radiation device 100 of the Figure 2AA radiation device 100 is used to deliver protons during or for radiotherapy of a patient P, who is positioned on a table 120 (ready for treatment). The first radiation device represents technology 100 (or technology A). A first support body 114 is rotatably mounted, and a radiation head 110 is attached to it, rigidly connected to the support body 114 via a bridge 112. The angle of the radiation head 110 relative to the patient P can be adjusted via the support body 114. The radiation dose and the distribution of the radiation within the proton beam (not shown) from the radiation head 110 are also adjustable. All these technical values, as setting parameters, are represented in a Paretofront for a patient over the entire fractional radiotherapy (radiotherapy). In the example, this can be the Paretofront 101 of Figure 1The technical values ​​as setting parameters of the beam head 110 are set via an I / O interface 731 from, for example, the 64-bit bus 701, which is located in Figure 12 as is evident.

[0040] It should be emphasized again that the claim is not made against the therapy itself using radiation device 100 (technology 100), but rather against the planning of that therapy. The reference to the therapy devices as radiation devices, which implement this planning later or functionally separately from the planning itself, serves to illustrate the point for the patient; the disclosure is not intended to relate to the patient's therapy. The planning and the therapy can easily be separated or distinguished both temporally and functionally.

[0041] The same applies to the following figures.

[0042] Figure 2BFigure 1 shows another radiation device, here a photon beam device 200 of technology 200 (or technology B). The patient P is placed on a table 220, and the beam head 210 for delivering the protons is arranged on an L-shaped bridge 212. The bridge 212 is rotatably connected to a stationary base 214, relative to which it can pivot. Here, too, the settings for the radiation delivery of the beam head 210 can be specified, and they can be used for fractionated treatment of a Paretofront, for example, the Paretofront 101 from Figure 1 , can be specified or set. The settings of the technical values ​​of the beam head 210 are made via an I / O interface 732 from, for example, the 64-bit bus 701, which is located in Figure 12 as is evident.

[0043] Figure 2CFigure 3 shows another radiation device 300 of the technology 300. Here, too, the patient P is placed on a table 320. A bridge 312 is pivotably mounted on a base 314, and the radiation head 310 is designed to emit accelerated photons. The emission of the accelerated photons from the radiation head 310 is adjusted so that they are tailored to the target and the risks, ensuring that, during the fractionated treatment session, the target is primarily targeted within its volume by the radiation, and the risks are shielded from radiation exposure. For this purpose, a multi-lamella collimator (not shown) can be provided, which is placed in the radiation head 310 and whose lamellae can be adjusted to any desired shape in order to create a suitable free space between them that corresponds as closely as possible to the target volume.The lamellae themselves are radiation-shielding, for example made of tungsten, so that the shape of the beam can be adjusted almost arbitrarily. In addition to this shape-defining adjustment of the beam volume, actually the beam surface, a regime can be applied to define the fields and angles at which the irradiations take place. The setting of the technical values ​​of the beam head 310, e.g., the multi-lamella collimator, is carried out via an I / O interface 733 from the aforementioned 64-bit bus 701, which is located in... Figure 12 as is evident.

[0044] Figure 2D shows another radiation device 300', which is similar to the one of the Figure 2C corresponds only to an older or technically outdated design that may correspond to the therapy device D described below. The older design is intended to express that it is a separate technology 300', which, although related to that of the therapy device of the Figure 2CIt is consistent, but it does not reflect the current state of the art. The components used here correspond to those of the Figure 2C They are symbolically marked with a line, i.e., (old) bridge 312', (old) base 314', and (old) beam head 310'. Patient P is placed on the (old) table 320'. "Old" stands for the older technology 300'. The technical settings of the older beam head 310' are adjusted via an I / O interface 734 from the aforementioned 64-bit bus 701, which is located in Figure 12 as is evident.

[0045] In the course of the Figures 4A to 4D This creates a field F which maps all combinations of achievable mixing ratios of two technologies with the Pareto fronts 601 and 701, and this with the target criteria c1 and c2.

[0046] Based on the Figure 4EThe formation of field F is explained. Two line segments travel along Pareto fronts 601 and 701. One segment, 80-90, is fixed at point 80 and moves from point 90 on Pareto front 601 to point 92. The swept area outlines a first group of points belonging to field F, not shown here. The second line segment also extends between points 90 and 80, but this segment is fixed at point 90 and runs along Pareto front 701 to point 82 (see also...). Figure 4E ). This is the second group of points in the field F. Together they form the field F. Its lower left boundary is the sum of the Pareto-optimal points whose connection yields the line segment KK or 801, the convex combination of points.

[0047] On route 801 of the Pareto-optimal points, the mixing ratio can be adjusted, i.e., changed in a navigable manner (during planning). Two points are highlighted, which result from the mixing ratio possible due to the availability of the radiation equipment. Figures 11A and 11B result.

[0048] This is point M2, marked by a square bracket, with approximately 67% of the Pareto front 601, which here represents radiation device A. Point M4, marked by an oppositely oriented square bracket, has, in contrast, approximately 67% of the radiation from radiation device B. Accordingly, approximately 33% of the mixture remains for the other radiation device.

[0049] Since the points to the right of M4 are closer to the Paretofront 701, the proportion of the Paretofront 701 is greater here. Point M3 has a 100% proportion of radiation device B. Point M1 lies on the Paretofront 601 and therefore has a 100% proportion of radiation device A. One point corresponds to a treatment plan, with its technical settings on the radiation device.

[0050] The two points M2 and M4 resulted from the availability of the therapy devices, specifically with regard to the Figures 11A / 11B . In the Figure 11AThe two radiation therapy units, TGerät A and TGerät B, are shown with their respective time slots for daily doses. The requirement to start as quickly as possible means that radiation therapy unit A cannot be scheduled. Only radiation therapy unit TGerät B is available as soon as possible. For planning purposes, there is availability for eleven daily doses on TGerät B before it is fully occupied. Afterward, the schedule can switch to radiation therapy unit A. The remaining 30 daily fractions, comprising 19 daily doses, are scheduled there. This results in a distribution of approximately one-third from radiation therapy unit B and approximately two-thirds from radiation therapy unit A. This results in the two "points" M2 and M4, marked by square brackets, on route KK or 801 in the... Figure 4E .

[0051] In a second example of the Figure 11BRadiation therapy machine A is initially booked for five days, thus preventing the earliest possible start of the planned therapy. Radiation therapy machine B is initially booked for only two days and then available for 15 days. However, the subsequent planned switch to therapy machine A is only possible for the following six days, with a further planned switch to therapy machine B for the remaining nine days of the assumed 30-day planning period for the entire fractionated therapy.

[0052] Changing the therapy device again may be medically advisable, but is not usually the primary goal. It could be medically advisable for two reasons. a. It protects a specific organ Z1. b. It burdens another organ Z2, which can withstand the burden.

[0053] It should be mentioned that the depicted point M1 is dominated by the Pareto front 601 with respect to criterion c2.

[0054] It will be at the Figure 11B It has been very well recognized that filling gaps in the availability of radiation equipment can also be a goal of planning, under the premise that it is medically sensible.

[0055] Based on the Figures 5A and 5B It is shown that navigation on route 801 (the sum of the Pareto-optimal points) can also be carried out using the sliders 21a and 22a of the operating aids 21 and 22, which are in Figure 1 shown.

[0056] Figure 7 A field F' illustrates the difference between two technologies, 901 and 1001, where one technology is strictly superior to the other. Therapies that are closer to function B, representing radiation device B, can be started earlier than treatment plans that are closer to function A.

[0057] Another possibility for the position of the Pareto fronts of the radiation devices A and B, corresponding to 601 and 701, is that there is a gap 1401 in the therapeutic window of criterion c1, which can be bridged by the distance 1301 with a mixture ratio of the two therapies to be planned (in the planning).

[0058] Result from Figure 9 Synergy effects: the section 801' adds another bulbous portion F2' to the common area F (in addition to the existing area F1').

[0059] Figure 12This figure shows a network-oriented representation of the control system via the aforementioned bus 701 and the connected and used digital components. In the preferred example, bus 701 is a 64-bit bus through which the digital components communicate with each other. It is bidirectional. The CPU 700 is provided for processing power and computational functions. It reads the functions 401 and 101, displayed on the display 10, from the memory 750 and forwards them to the display unit I / O 760 via bus 701. In the display unit 760, the data is processed and displayed according to the technical type of display 10.

[0060] The navigation environment of the Figure 1It is operated via the function pointer M, which is moved and activated by the planner using a mouse device, in this example a trackball M' (selection of a function at the point where the pointer M is located). The trackball M' is wirelessly coupled to a receiver 710, which converts its movement signals and forwards them to bus 701. This coupling is not bidirectional.

[0061] Display 10 is assigned to the mouse device M', e.g., the trackball, which enables the functions of pointing and operation (triggering a function), at the location of the mouse pointer M.

[0062] The mouse pointer M is also used to operate both operating aids 21 and 22 for the criteria c1 and c2.

[0063] An alternative display, the 781, is that of a tablet, the 780, which has the same display. Figure 1The tablet is equipped with a display that is shown on the touch-sensitive display 781. The screen display or tablet display has a patch area 1 and an operating area 2, as previously explained. The tablet 780 is connected to the bus 701 via a WLAN connection (or link) with a WLAN transmitter and receiver 770. The mouse pointer is replaced by the finger (as shown) and controlled by gestures (e.g., swipe, tap, double tap) on the display 781 of the screen-enabled or touch-sensitive tablet 780.

[0064] The technological radiation devices 100 to 300' are each connected to bus 701 via an input / output device 731, 732, 733 and 734. Each of these input / output devices is bidirectional, meaning it can transmit setting parameters from bus 701 to the respective radiation device.

[0065] Preferably, each of these radiation devices (100, 200, ...) has sufficient storage space of at least 500GB so that it can save the preset parameters of the subsequent therapy and adjust them independently during the therapy, especially for fractionated sessions of the patients over the planning period.

[0066] In this example, I / O 1 sends the setting parameters to the radiation device 100 for proton delivery. This device is then able to apply the parameters to be set—actually, the parameters already predefined for the technology 100 "protons"—during the fractionated therapy of patient P, which is spread over several days. This means delivering the doses, intensities, and directions of proton radiation (in radiotherapy) to this individual patient P. Here, the functional separation of planning and therapy takes place.

[0067] This example can also be controlled so that the parameters in memory 750 are stored for the duration of the fractionated therapy and are only transmitted to the radiation device 100 at the times before each therapy session. This fractionated therapy is a fractional programming of the respective radiation device 100 to 300 (in the sense of fractional data transmission of the currently required time segment of the therapy, e.g., 30 days). The actual therapy is carried out automatically by the radiation device 100, without the previously completed planning.

[0068] In the same way, the other devices 200, 300 and 300' are programmed, prepared for therapy and conditioned in terms of data technology.

[0069] It must be emphasized again that no therapy is performed simultaneously with the planning; the therapy is fully planned and functionally prepared (i.e., completely planned) before the respective device administers this radiotherapy to the patient. The latter therapy is not currently in use.

[0070] Navigation via the displayed patches on Display 10 can only be completed by the planner in order to later transfer them to the associated radiation device(s) via the respective Input / Output Device(s) 731 to 734.

Claims

1. Method for designing or creating a therapy as a treatment plan, prior to treatment and with interactive navigation on a display device (10) (a) wherein at least two technologies (A, B) of at least two radiation devices (100, 200, 300, 300') are displayed on a display device (10) and are available for selection, providing at least one technology (A) of a first radiation device (100) and at least one technology (B) of a second radiation device (200); (b) for a person (P) to be treated according to the designed or configurate , who has a treatable disease that is treated by non-concurrent fractionated doses from the at least two radiation devices (100, 200), wherein the designed or configured treatment plan defines a plurality of technical settings that are set on the radiation devices prior to treatment; characterised in that (c1) on the display device (10) for the at least two technologies (A, B), a Pareto front (601, 701) is displayed for each of at least two criteria (c1, c2); (c2) a combined Pareto front (801) is formed from a field (F, F') of the two criteria (c1, c2), arising from convex combinations of at least support points of the first and second Pareto fronts (601, 701); (c3) an area section is formed as a field (F, F'); so that a line of limited length is formed from the field (F, F'), which forms the combined Pareto front (801), is made available for interactive navigation of a mixture ratio of at least two technologies (A, B) and is used for planning, for designing or creating the treatment plan as a point on the combined Pareto front (801).

2. Method according to claim 1, wherein interpolated intermediate values of the support points are also mapped by the convex combination at new points adjacent to the Pareto fronts.

3. Method according to claim 1 or 2, wherein the line as a combined Pareto front (801) does not intersect the Pareto fronts (601, 701).

4. Method according to one of the previous claims, wherein the new points formed by convex combinations adjacent to the Pareto fronts (601, 701) span the field (F, F') in the therapeutic window (f).

5. Method according to one of the previous claims, wherein the planning point on the combined Pareto front (801) has fractional proportions of the technology (A) of the first radiation device (100) and fractional proportions of the technology (B) of a second radiation device (200).

6. Method according to both of the preceding claims, wherein sets of points are combined to form an area section, and these are put into a relationship that is limited by the temporal availability of the at least two radiation devices (100, 200, 300, 300').

7. Using a display device (10) for designing or planning a therapy as a treatment plan, prior to treatment and with interactive navigation on the display device (10) using the combined Pareto front (801) according to one of claims 1 to 6.

8. Use according to claim 7, designed for designing or creating the treatment plan as a point on the combined Pareto front (801).