Physically constrained voxel-based penalty adaptation for ultra-fast IMRT planning.

Conventional treatment planning in intensity-modulated radiation therapy (IMRT) is a trial-and-error process that usually involves tedious tweaking of optimization parameters. Here, we present an algorithm that automates part of this process, in particular the adaptation of voxel-based penalties within normal tissue. Thereby, the proposed algorithm explicitly considers a priori known physical limitations of photon irradiation. The efficacy of the developed algorithm is assessed during treatment planning studies comprising 16 prostate and 5 head and neck cases. We study the eradication of hot spots in the normal tissue, effects on target coverage and target conformity, as well as selected dose volume points for organs at risk. The potential of the proposed method to generate class solutions for the two indications is investigated. Run-times of the algorithms are reported. Physically constrained voxel-based penalty adaptation is an adequate means to automatically detect and eradicate hot-spots during IMRT planning while maintaining target coverage and conformity. Negative effects on organs at risk are comparably small and restricted to lower doses. Using physically constrained voxel-based penalty adaptation, it was possible to improve the generation of class solutions for both indications. Considering the reported run-times of less than 20 s, physically constrained voxel-based penalty adaptation has the potential to reduce the clinical workload during planning and automated treatment plan generation in the long run, facilitating adaptive radiation treatments.

Lung stereotactic body radiotherapy with an MR-linac - Quantifying the impact of the magnetic field and real-time tumor tracking.

BACKGROUND AND PURPOSE: There are concerns that radiotherapy doses delivered in a magnetic field might be distorted due to the Lorentz force deflecting secondary electrons. This study investigates this effect on lung stereotactic body radiotherapy (SBRT) treatments, conducted either with or without multileaf collimator (MLC) tumor tracking. MATERIAL AND METHODS: Lung SBRT treatments with an MR-linac were simulated for nine patients. Two different treatment techniques were compared: conventional, non-tracked deliveries and deliveries with real-time MLC tumor tracking, each conducted either with or without a 1.5T magnetic field. RESULTS: Slight dose distortions at air-tissue-interfaces were observed in the presence of the magnetic field. Most prominently, the dose to 2% of the skin increased by 1.4Gy on average. Regardless of the presence of the magnetic field, MLC tracking was able to spare healthy tissue, for example by decreasing the mean lung dose by 0.3Gy on average, while maintaining the target dose. CONCLUSIONS: Accounting for the magnetic field during treatment plan optimization allowed for design and delivery of clinically acceptable lung SBRT treatments with an MR-linac. Furthermore, the ability of MLC tumor tracking to decrease dose exposure of healthy tissue, was not inhibited by the magnetic field.