Four-dimensional intensity-modulated radiation therapy planning for dynamic tracking using a direct aperture...

Planning for the delivery of intensity-modulated radiation therapy (IMRT) to a moving target, referred to as four-dimensional (4D) IMRT planning, is a crucial step for achieving the treatment objectives for sites that move during treatment delivery. The authors proposed a simplistic method that accounts for both rigid and nonrigid respiration-induced target motion based on 4D computed tomography (4DCT) data sets.

A set of MLC apertures and weights was first optimized on a reference phase of a 4DCT data set. At each beam angle, the apertures were morphed from the reference phase to each of the remaining phases according to the relative shape changes in the beam's eye view of the target. Three different planning schemes were evaluated for two lung cases and one pancreas patient: (1) Individually optimizing each breathing phase; (2) optimizing the reference phase and shifting the optimized apertures to other breathing phases based on a rigid-body image registration; and (3) optimizing the reference phase and deforming the optimized apertures to the other phases based on the deformation and translation of target contours. Planning results using scheme 1 serves as the "gold standard" for plan quality assessment; scheme 2 is the method previously proposed in the literature; and scheme 3 is the method the authors proposed in this article. The optimization results were compared between the three schemes for all three cases.

The proposed scheme 3 is comparable to scheme 1 in plan quality, and provides improved target coverage and conformity with similar normal tissue dose compared with scheme 2.

Direct aperture deformation method for 4D IMRT planning improves upon methods that only consider rigid-body motion and achieves a plan quality close to that optimized for each of the phases.