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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Photon optimizer (PO) vs progressive resolution optimizer (PRO): a conformality- and complexity-based comparison for

Diana Binny1, Tanya Kairn2, Craig M Lancaster3

  • 1Radiation Oncology Centres, Redlands, Australia; Queensland University of Technology, Brisbane, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Medical Dosimetry : Official Journal of the American Association of Medical Dosimetrists
|October 29, 2017
PubMed
Summary

The new photon optimizer (PO) offers comparable target coverage and improved organ-at-risk sparing in intensity-modulated arc therapy (IMAT) plans versus the progressive resolution optimizer (PRO). However, PO plans show increased complexity and monitor units, requiring careful evaluation.

Keywords:
Monitor unit indicesOptimizationPhoton optimizerProgressive resolution optimizer

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Planning

Background:

  • Intensity-modulated arc therapy (IMAT) is a widely used radiotherapy technique.
  • Optimizers play a crucial role in developing efficient and effective IMAT plans.
  • Comparing novel optimizers with established ones is essential for clinical adoption.

Purpose of the Study:

  • To compare the performance of the photon optimizer (PO) against the progressive resolution optimizer (PRO) for IMAT.
  • To evaluate plan conformity, target coverage, organ-at-risk sparing, and plan complexity.
  • To provide guidance on the advantages and limitations of PO in clinical settings.

Main Methods:

  • Eleven diverse treatment plans (prostate, head and neck, brain) were generated using both PRO and PO algorithms.
  • A standardized plan template with identical objectives and iterations was used for comparability.
  • Plan analysis included conformity metrics (coverage factor, conformation number, homogeneity) and complexity metrics (MLC variability, modulation scores, monitor units).

Main Results:

  • Both PRO and PO achieved comparable target volume coverage and dose conformity across most sites.
  • PO plans demonstrated generally improved organ-at-risk sparing compared to PRO plans.
  • PRO plans exhibited lower complexity, with reduced MLC leaf variability and monitor unit usage than PO plans.

Conclusions:

  • The photon optimizer (PO) can produce IMAT plans with similar target conformity and enhanced organ-at-risk sparing compared to the progressive resolution optimizer (PRO).
  • PO-optimized plans may present higher multileaf collimator variability and monitor unit requirements.
  • Clinical implementation of PO necessitates careful assessment of plan conformity and complexity to ensure deliverability.