Many-isocenter optimization for robotic radiotherapy

Lyu, Qihui; Neph, Ryan; Yu, Victoria Y.; Ruan, Dan; Boucher, Salime; Sheng, Ke

doi:10.1088/1361-6560/ab63b8

Title: Many-isocenter optimization for robotic radiotherapy

Journal Article · Mon Feb 10 00:00:00 EST 2020 · Physics in Medicine and Biology (Online)

DOI:https://doi.org/10.1088/1361-6560/ab63b8· OSTI ID:1803104

^[1]; Neph, Ryan ^[1]; Yu, Victoria Y. ^[1];

^[1]; Boucher, Salime ^[2]; Sheng, Ke ^[1]

Univ. of California, Los Angeles, CA (United States). Dept. of Radiation Oncology
RadiaBeam Technologies, Santa Monica, CA (United States)

Despite significant dosimetric gains, clinical implementation of the 4π non-coplanar radiotherapy on the widely available C-arm gantry system is hindered by limited clearance, and the need to perform complex coordinated gantry and couch motion. A robotic radiotherapy platform would be conducive to such treatment but a new conflict between field size and MLC modulation resolution needs to be managed for versatile applications. This study investigates the dosimetry and delivery efficiency of purposefully creating many isocenters to achieve simultaneously high MLC modulation resolution and large tumor coverage. An integrated optimization framework was proposed for simultaneous beam orientation optimization (BOO), isocenter selection, and fluence map optimization (FMO). The framework includes a least-square dose fidelity objective, a total variation term for regularizing the fluence smoothness, and a group sparsity term for beam selection. A minimal number of isocenters were identified for efficient target coverage. Colliding beams excluded, high-resolution small-field 4π intensity-modulated radiotherapy (IMRT) treatment plans with 50 cm source-to-isocenter distance (SID-50) on 10 Head and Neck (H&N) cancer patients were compared with low-resolution large-field plans with 100 cm SID (SID-100). With the same or better target coverage, the average reduction of [Dmean, Dmax] of 20-beam SID-50 plans from 20-beam SID-100 plans were [2.09 Gy, 1.19 Gy] for organs at risk (OARs) overall, [3.05 Gy, 0.04 Gy] for parotid gland, [3.62 Gy, 5.19 Gy] for larynx, and [3.27 Gy, 1.10 Gy] for mandible. R50 and integral dose were reduced by 5.3% and 9.6%, respectively. Wilcoxon signed-rank test showed significant difference (p < 0.05) in planning target volume (PTV) homogeneity, PTV Dmax, R50, Integral dose, and OAR Dmean and Dmax. The estimated delivery time of 20-beam [SID-50, SID-100] plans were [19, 18] min and [14, 9] min, assuming 5 fractions and 30 fractions, respectively. Finally, with clinically acceptable delivery efficiency, many-isocenter optimization is dosimetrically desirable for treating large targets with high modulation resolution on the robotic platform.

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Research Organization:: RadiaSoft, LLC, Boulder, CO (United States); RadiaBeam Technologies, Santa Monica, CA (United States)

Sponsoring Organization:: USDOE Office of Science (SC), Engineering & Technology. Office of Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs; National Institutes of Health (NIH)

Grant/Contract Number:: SC0017057; SC0017687; R01CA188300; R01CA230278; R21CA228160; R44CA183390

OSTI ID:: 1803104

Journal Information:: Physics in Medicine and Biology (Online), Vol. 65, Issue 4; ISSN 1361-6560

Publisher:: IOP PublishingCopyright Statement

Country of Publication:: United States

Language:: English

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