Fast approximate delivery of fluence maps for IMRT and VMAT.

In this article we provide a method to generate the trade-off between delivery time and fluence map matching quality for dynamically delivered fluence maps. At the heart of our method lies a mathematical programming model that, for a given duration of delivery, optimizes leaf trajectories and dose rates such that the desired fluence map is reproduced as well as possible. We begin with the single fluence map case and then generalize the model and the solution technique to the delivery of sequential fluence maps. The resulting large-scale, non-convex optimization problem was solved using a heuristic approach. We test our method using a prostate case and a head and neck case, and present the resulting trade-off curves. Analysis of the leaf trajectories reveals that short time plans have larger leaf openings in general than longer delivery time plans. Our method allows one to explore the continuum of possibilities between coarse, large segment plans characteristic of direct aperture approaches and narrow field plans produced by sliding window approaches. Exposing this trade-off will allow for an informed choice between plan quality and solution time. Further research is required to speed up the optimization process to make this method clinically implementable.