title: Evaluation of optimization strategies and the effect of initial conditions on IMAT optimization using a leaf position optimization algorithm.
abstract: Intensity-modulated arc therapy (IMAT) is a rotational variant of intensity-modulated radiation therapy (IMRT) that can be implemented with or without angular dose rate variation. The purpose of this study is to assess optimization strategies and initial conditions using a leaf position optimization (LPO) algorithm altered for variable dose rate IMAT. A concave planning target volume (PTV) with a central cylindrical organ at risk (OAR) was used in this study. The initial IMAT arcs were approximated by multiple static beams at 5 degrees angular increments where multi-leaf collimator (MLC) leaf positions were determined from the beam's eye view to irradiate the PTV but avoid the OAR. For the optimization strategy, two arcs with arc ranges of 280 degrees and 150 degrees were employed and plans were created using LPO alone, variable dose rate optimization (VDRO) alone, simultaneous LPO and VDRO and sequential combinations of these strategies. To assess the MLC initialization effect, three single 360 degrees arc plans with different initial MLC configurations were generated using the simultaneous LPO and VDRO. The effect of changing optimization degrees of freedom was investigated by employing 3 degrees , 5 degrees and 10 degrees angular sampling intervals for the two 280 degrees , two 150 degrees and single arc plans using LPO and VDRO. The objective function value, a conformity index, a dose homogeneity index, mean dose to OAR and normal tissues were computed and used to evaluate the treatment plans. This study shows that the best optimization strategy for a concave target is to use simultaneous MLC LPO and VDRO. We found that the optimization result is sensitive to the choice of initial MLC aperture shapes suggesting that an LPO-based IMAT plan may not be able to overcome local minima for this geometry. In conclusion, simultaneous MLC leaf position and VDRO are needed with the most appropriate initial conditions (MLC positions, arc ranges and number of arcs) for IMAT.
authors.affiliation: Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada. michael.oliver@lhsc.on.ca
authors.forename: Mike
authors.initials: M
authors.lastname: Oliver
authors.forename: Michael
authors.initials: M
authors.lastname: Jensen
authors.forename: Jeff
authors.initials: J
authors.lastname: Chen
authors.forename: Eugene
authors.initials: E
authors.lastname: Wong
mesh_terms: D000465:Algorithms; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013997:Time Factors