Dosimetric Impact of Hidden Input Parameters in Inverse Optimization Algorithms for GYN HDR Brachytherapy

Inverse optimization (IO) algorithms are used in GYN HDR brachytherapy planning, with user parameter settings embedded in commercial TPS. To examine the dosimetric influence of hidden input parameters in three IO algorithms-IPSA, HIPO, and MCO-for GYN HDR brachytherapy across two applicator types. In-house implementations of IPSA, HIPO, and MCO were implemented and evaluated against retrospectively generated commercial TPS plans (Oncentra Brachy) using identical clinical input parameters across 24 cervical cancer cases (18 T&O; 6 T&O+Needles (T&O+N)). Each IO algorithm was assessed using 1k combinations of hidden parameters (e.g., dwell-time modulation constraints, convergence thresholds). Cumulative DVH curves and dosimetric indices (HR-CTV D98/D90, OAR D2cc) were compared with commercial plans. Standard deviations (SD) of DVH differences were used to characterize sensitivity to hidden parameters. For HR-CTV, SD values in T&O+N cases reached 23.0 Gy and 7.1 Gy for MCO and HIPO, respectively, with corresponding average values of 55.8 Gy and 19.7 Gy. In T&O cases, HR-CTV SD values reached 4.9 Gy and 3.3 Gy for HIPO and IPSA, respectively, with average values of 20.1 Gy and 8.6 Gy. MCO exhibited the highest sensitivity, followed by HIPO and IPSA. T&O+N cases showed greater sensitivity than T&O cases. Absolute differences in HR-CTV D90 (D98) relative to commercial algorithms reached up to 33.3 Gy (28.4) for T&O+N cases and 10.8 Gy (8.5) for T&O cases. For OARs, absolute D2cc differences in T&O+N (T&O) cases reached up to 8.6 Gy (2.3) for rectum, 17 Gy (10.2) for bladder, 14.8 Gy (3.9) for sigmoid, and 7.0 Gy (8.1) for bowel. Hidden input parameter settings significantly impact on GYN HDR plans, with target coverage up to 28.4 Gy across IO algorithms for both T&O and T&O+N cases. The findings in this study shown the potential to improve plans through hidden input parameter optimization.