title: Dose correction strategy for the optimization of volumetric modulated arc therapy.
abstract: OBJECTIVE
  Dose calculation during optimization of volumetric modulated arc therapy (VMAT) is necessarily simplified to keep computation time manageably low; however the approximations used in the scatter dose calculation lead to discrepancy with more accurate dose calculation following optimization. The purpose of this study is to develop a dose correction strategy in optimization that can minimize the disagreement.
  
  
  METHODS
  VMAT delivery is modeled using a number of static equispaced beams. Dose correction factors (C(ij)) are associated with each beam i and point j inside the region of interest. C(ij) is calculated as the ratio of dose obtained from the full scatter dose calculation over that from the partial scatter dose calculation in optimization. VMAT optimization algorithm is a multiple resolution approach. The dose correction factors are calculated at the beginning of each resolution and applied as multiplicative corrections to the partial scatter dose during optimization. Clinical cases for brain, prostate, paraspinal, and esophagus are utilized to evaluate the method. Treatment plans created with and without the correction scheme are normalized such that the complication rates of organs at risk (OARs) are comparable. The resulting planning target volume (PTV) mean doses are used to compare plan quality.
  
  
  RESULTS
  The difference between the dose calculated at the end of optimization and at the end of the final forward dose calculation is reduced from 7% and 5% for the PTV and OAR mean doses without correction to approximately 1% with correction. Applying dose correction during optimization saves planners 2-4 h in average in treatment planning, and has a positive impact on plan quality, evidenced by a noticeably higher PTV mean dose: 2.1%, 2.4%, 0.5%, and 9.3% of the corresponding prescription dose in the brain, esophagus, prostate, and paraspinal cases, respectively.
  
  
  CONCLUSIONS
  When dose correction is applied during optimization, dose discrepancies between optimization and full dose calculation are reduced. Integrating dose correction in VMAT optimization allows planners to adjust the optimization constraints more easily and confidently during optimization and has the potential to improve plan quality.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. zhangp@mskcc.org
authors.forename: Pengpeng
authors.initials: P
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Yang
authors.forename: Margie
authors.initials: M
authors.lastname: Hunt
authors.forename: Gig
authors.initials: G
authors.lastname: Mageras
mesh_terms: D003198:Computer Simulation; D006801:Humans; D008954:Models, Biological; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy*