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Inverse-planned deliverable 4D-IMRT for lung SBRT
Mahdi Hamzeei1, Arezoo Modiri1, Narges Kazemzadeh1
1School of Medicine, University of Maryland, 685 W Baltimore St., Baltimore, MD, 21201, USA.
Medical Physics
|August 29, 2018
Summary
Particle Swarm Optimization (PSO)-based four-dimensional (4D) intensity-modulated radiation therapy (IMRT) improves organ at risk sparing in lung stereotactic body radiotherapy (SBRT). Optimized aperture sequencing ensures efficient delivery of complex 4D-IMRT plans.
Area of Science:
- Radiation Oncology
- Medical Physics
- Computational Biology
Background:
- Lung stereotactic body radiotherapy (SBRT) requires precise radiation delivery to target tumors while minimizing dose to surrounding organs at risk (OARs).
- Four-dimensional (4D) imaging accounts for respiratory motion, offering potential for improved OAR sparing by adapting treatment delivery to the tumor's dynamic position.
- Conventional intensity-modulated radiation therapy (IMRT) planning typically uses 3D data and may not fully exploit the potential of 4D motion for OAR sparing.
Purpose of the Study:
- To develop and evaluate a particle swarm optimization (PSO)-based technique for creating deliverable 4D-IMRT plans for lung SBRT.
- To utilize respiratory motion as an additional degree of freedom to enhance OAR sparing in 4D-IMRT.
- To present an optimization-based aperture sequencing technique for efficient delivery of 4D-IMRT plans with a large number of apertures.
Main Methods:
- A GPU-enabled PSO inverse planning engine integrated with the Eclipse treatment planning system was used to generate 4D-IMRT plans.
- Retrospective 4D CT scans and clinical beam configurations from seven lung cancer patients were utilized.
- A mixed integer optimization technique was developed for aperture sequencing, considering leaf velocity, monitor units (MUs), and respiratory phase duration to maximize delivery efficiency.
Main Results:
- 4D-IMRT plans achieved comparable planning target volume (PTV) coverage to clinical plans.
- Significant improvements in OAR sparing were observed: 39.7% for the heart, 20.5% for the esophagus, 25.6% for the spinal cord, and 2.1% for the lungs.
- The proposed aperture sequencing method reduced delivery cycles by 15.94% (4s cycle) and 15.14% (6s cycle) compared to a greedy algorithm.
Conclusions:
- PSO-based 4D-IMRT is a promising technique for enhancing OAR sparing in lung SBRT.
- Efficient delivery of 4D-IMRT plans with numerous apertures is achievable through optimized aperture sequencing.
- The developed method allows for clinically feasible delivery times for complex 4D-IMRT plans.
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