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• W2100035448 abstract "Purpose: Both rotational and gantry-fixed intensity-modulated radiation therapy (IMRT) have been implemented clinically using dynamic multileaf collimation (DMLC). Current inverse planning methods for IMRT predetermines which of the two methods is used for delivery. The range of the arcs or the number and the orientations of the beams are also selected by the user. Planning optimization is nothing more than finding the intensity maps for the selected beams to meet the dose-volume constraints. We believe that due to the limited scope of optimization, neither the rotational nor the gantry-fixed method alone is truly optimal in terms of dose conformity and efficiency of delivery. The goal of this study is to expend the scope of IMRT optimization to include the mode of delivery, the number and orientation of beams. Materials and methods: An optimization algorithm is used to generate beam intensities at all beam angles. The final value of the cost function is recorded as the baseline cost with all beams present. Then, a beam is deleted from the initial set and the intensities for the remaining beams are re-optimized. The difference between the new and the baseline cost represents the cost of deleting the beam at the specific angle. The angular cost, G, for all beam angles, θ, are evaluated. Alternatively, G(θ) can be evaluated by subtracting the dose contribution from the beam angle θ instead of deleting the beam and re-optimization. G(θ) derived with either approach was used to determine the optimal delivery technique. If G(θ) peaks at certain angles, fixed fields at these angles will be used. If G(θ) is flat, indicating no advantage of any angle, rotational delivery will be chosen. In most cases, G(θ) fluctuates over a smooth background. The optimal dose distribution and efficient delivery can be achieved using a combination of rotational and fixed-gantry IMRT. The range of the arcs, and the number of beams to use as well as their orientations are inherently included in the optimization. Results: The angular cost, G(θ), as described above serves as an accurate measure of the relative importance of all the beam angles. Because the beams neighboring and opposite the deleted beam compensate for the missing beam angle in the re-optimization process, the sensitivity of G(θ) derived with re-optimization depends on the angular spacing used for the evaluation. The range of G(θ) increases with angular spacing of the beams and with avoidance of directly opposed beam. Although the G(θ) evaluated by subtracting the dose contribution from the beam at the angle θ is theoretically less stringent than with re-optimization, the results with both methods are similar. The importance factors are useful for selecting the most efficient delivery method as well as the optimal beam angles in cases where the preference of gantry-fixed delivery is indicated. Compared to pure rotational or gantry-fixed IMRT, the hybrid approach provides equivalent or improved dose conformity with fewer beams if an arc is counted as a beam. Conclusion: The current IMRT methods with limited-scope optimization introduce inefficiency in delivery and cannot explore the full potential of IMRT. The method developed using the concept of angular cost makes it feasible for inverse planning to incorporate the selection of the delivery method, the number of beams to use and their orientations. Since both rotational and gantry-fixed delivery methods are possible on a linear accelerator with DMLC capability, the optimized hybrid delivery scheme can improve dose conformity as well as efficiency in delivery." @default.
• W2100035448 created "2016-06-24" @default.
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• W2100035448 date "2001-11-01" @default.
• W2100035448 modified "2023-09-27" @default.
• W2100035448 title "Angular cost—a new concept for broad scope planning optimization" @default.
• W2100035448 doi "https://doi.org/10.1016/s0360-3016(01)02571-8" @default.
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