title: Beam-orientation optimization of intensity-modulated radiotherapy: clinical application to parotid gland tumours.
abstract: OBJECTIVE
  An optimization algorithm has been developed to determine the best beam-arrangement for a small number of intensity-modulated radiotherapy (IMRT) fields. The algorithm is designed to avoid, if possible, beam-orientations that pass through organs-at-risk (OARs) with low radiation tolerance.
  
  
  METHODS
  An independent, fast IMRT algorithm based on the Bortfeld algorithm was developed to determine the profile of the intensity-modulated beams (IMBs) for each beam-arrangement and a fast-simulated-annealing algorithm finds the 'optimal' beam-arrangement. The final beam-arrangement was transferred to the CORVUS (NOMOS Corporation) treatment planning system, and the IMBs were re-optimized for comparison with a standard nine-field, equi-spaced arrangement. The algorithm has been initially tested on a single example patient, with a parotid gland carcinoma.
  
  
  RESULTS
  The nine-field, IMRT plan for an example patient with a parotid gland tumour significantly reduced the dose to the cochlea compared with the conformal radiotherapy plan. In addition, the planning-target-volume (PTV) homogeneity was improved, but the plan produced a higher dose to the contralateral parotid (73% of the OAR received more than 6 Gy). The beam-orientation optimization algorithm produced a three-field plan that greatly reduced the dose to the contralateral parotid (maximum dose of 2 Gy), whilst maintaining the PTV dose homogeneity and the reduced cochlear dose of the nine-field plan. Some changes in the dose to the other OARs, namely the brain and the oral cavity, were seen, but were deemed not to be clinically significant.
  
  
  CONCLUSIONS
  In conclusion, IMB-orientation optimization for head and neck treatment sites can produce improvements in treatment plans with only a few fields.
authors.affiliation: Joint Department of Physics, Institute of Cancer Research & The Royal Marsden NHS Trust, Downs Road, Sutton, SM2 5PT, Surrey, UK.
authors.forename: C G
authors.initials: CG
authors.lastname: Rowbottom
authors.forename: C M
authors.initials: CM
authors.lastname: Nutting
authors.forename: S
authors.initials: S
authors.lastname: Webb
mesh_terms: D000465:Algorithms; D006801:Humans; D010307:Parotid Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*