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Constrained optimization towards marker-based tumor tracking in VMAT.

Azeez Omotayo1,2, Sankar Venkataraman1,2,3, Boyd McCurdy1,2,3

  • 1CancerCare Manitoba, Division of Medical Physics, 675 McDermot Avenue, Winnipeg, MB R3E 0V9, Canada.

Biomedical Physics & Engineering Express
|January 11, 2022
PubMed
Summary
This summary is machine-generated.

This study integrates marker visibility constraints into Volumetric Modulated Arc Therapy (VMAT) planning. This approach enhances real-time tumor tracking success while maintaining critical dosimetric objectives for cancer treatment.

Keywords:
SBRTVMAT plansconstrained optimizationfiducial markersoptimizationtumor motion trackingvisibility constraints

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Planning

Background:

  • Real-time tumor tracking in radiotherapy enhances treatment accuracy.
  • Volumetric Modulated Arc Therapy (VMAT) is a widely used advanced radiotherapy technique.
  • Integrating fiducial marker visibility with treatment planning is crucial for effective tumor tracking during VMAT delivery.

Purpose of the Study:

  • To investigate the impact of incorporating marker-based visibility constraints into VMAT optimization.
  • To determine if these constraints can simultaneously ensure successful real-time tumor tracking and meet dosimetric objectives.
  • To evaluate the clinical applicability across various disease sites.

Main Methods:

  • Utilized radiotherapy optimization software (MonArc) incorporating novel 'hard' and 'soft' marker visibility constraints.
  • Developed VMAT plans for prostate, liver, and lung cancer patients with three fiducial markers.
  • Compared dose distributions and metrics (conformity index, homogeneity index, PTV/OAR doses) between constrained and non-constrained plans.

Main Results:

  • Visibility of fiducial markers in Multi-Leaf Collimator (MLC) apertures increased significantly with stronger constraints (32% to 100%).
  • Constrained plans showed minor deterioration in dose metrics (e.g., -6% to -15% PTV index) but maintained acceptable dosimetric objectives in over 90% of patients.
  • Non-constrained plans generally offered superior PTV conformity and lower OAR doses.

Conclusions:

  • Marker and tumor visibility constraints can be successfully integrated with dosimetric objectives in VMAT planning.
  • This integrated approach improves the likelihood of successful real-time tumor tracking during VMAT delivery.
  • The method is clinically applicable across multiple disease sites, balancing tracking and dosimetry needs.