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Multiple source-to-isocenter-distance (SID) optimization for 4πrobotic radiotherapy.

Jingjie Yu1, Qifan Xu1, Shusen Jing1

  • 1Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94115, United States of America.

Physics in Medicine and Biology
|October 23, 2025
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Summary
This summary is machine-generated.

This study introduces a Multi-Source-to-Isocenter Distance (SID) optimization for 4π intensity-modulated radiation therapy (IMRT) using robotic arms. This novel approach significantly improves treatment plan quality, including target coverage and organ-at-risk sparing, compared to fixed SID methods.

Keywords:
4π radiotherapyrobotic radiotherapyvariable SID planning

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Robotics in Medicine

Background:

  • Conventional 4π radiotherapy often assumes a fixed source-to-isocenter distance (SID), limiting flexibility on standard C-arm linear accelerators.
  • Variable SIDs are achievable with robotic radiotherapy platforms, enabling non-coplanar and non-isocentric delivery without patient repositioning.
  • Larger SIDs enhance tumor coverage and field-of-view, while shorter SIDs improve modulation resolution.

Purpose of the Study:

  • To develop and evaluate a Multi-SID optimization framework for robotic 4π intensity-modulated radiation therapy (IMRT).
  • To simultaneously optimize beam orientation, isocenter selection, SID selection, and fluence maps.
  • To assess the dosimetric benefits of Multi-SID planning compared to fixed-SID approaches in head-and-neck cancer cases.

Main Methods:

  • A Multi-SID optimization framework was created, incorporating dose fidelity, fluence smoothness, and selection sparsity objectives.
  • The planning system utilized a large candidate beam pool with over 1000 orientations, 10 SID levels (50-95 cm), and 5-9 isocenters.
  • Multi-SID IMRT plans were compared against fixed-SID (50 cm and 100 cm) plans for 10 head-and-neck cancer patients.

Main Results:

  • Multi-SID plans consistently demonstrated superior quality across all evaluated patients.
  • Key dosimetric improvements included enhanced target volume homogeneity (D95/D5) and dose conformity (Paddick CI).
  • Statistically significant improvements in organ-at-risk (OAR) sparing and reduced high-dose regions (R50) were observed with the Multi-SID method.

Conclusions:

  • The Multi-SID optimization framework effectively leverages variable SIDs to achieve superior dosimetric outcomes in robotic 4π IMRT.
  • This approach offers better target coverage and modulation resolution compared to traditional fixed-SID techniques.
  • Multi-SID planning represents a significant advancement for optimizing radiotherapy treatment plans, potentially leading to more effective and efficient cancer treatment.