A hybrid column generation and simulated annealing algorithm for direct aperture optimization

The purpose of this work was to develop a hybrid column generation (CG) and simulated annealing (SA) algorithm for direct aperture optimization (H-DAO) and to show its effectiveness in generating high quality treatment plans for intensity modulated radiation therapy (IMRT) and mixed photon-electron beam radiotherapy (MBRT). The H-DAO overcomes limitations of the CG-DAO with two features improving aperture selection (branch-feature) and enabling aperture shape changes during optimization (SA-feature). The H-DAO algorithm iteratively adds apertures to the plan. At each iteration, a branch is created for each field provided. First, each branch determines the most promising aperture of its assigned field and adds it to a copy of the current apertures. Afterwards, the apertures of each branch undergo an MU-weight optimization followed by an SA-based simultaneous shape and MU-weight optimization and a second MU-weight optimization. The next H-DAO iteration continues the branch with the lowest objective function value. IMRT and MBRT treatment plans for an academic, a brain and a head and neck case generated using the CG-DAO and H-DAO were compared. For every investigated case and both IMRT and MBRT, the H-DAO leads to a faster convergence of the objective function value with number of apertures compared to the CG-DAO. In particular, the H-DAO needs about half the apertures to reach the same objective function value as the CG-DAO. The average aperture areas are 27% smaller for H-DAO than for CG-DAO leading to a slightly larger discrepancy between optimized and final dose. However, a dosimetric benefit remains. The H-DAO was successfully developed and applied to IMRT and MBRT. The faster convergence with number of apertures of the H-DAO compared to the CG-DAO allows to select a better compromise between plan quality and number of apertures.

TriB-RT: Simultaneous optimization of photon, electron and proton beams

PURPOSE

To develop a novel treatment planning process (TPP) with simultaneous optimization of modulated photon, electron and proton beams for improved treatment plan quality in radiotherapy.

METHODS

A framework for fluence map optimization of Monte Carlo (MC) calculated beamlet dose distributions is developed to generate treatment plans consisting of photon, electron and spot scanning proton fields. Initially, in-house intensity modulated proton therapy (IMPT) plans are compared to proton plans created by a commercial treatment planning system (TPS). A triple beam radiotherapy (TriB-RT) plan is generated for an exemplary academic case and the dose contributions of the three particle types are investigated. To investigate the dosimetric potential, a TriB-RT plan is compared to an in-house IMPT plan for two clinically motivated cases. Benefits of TriB-RT for a fixed proton beam line with a single proton field are investigated.

RESULTS

In-house optimized IMPT are of at least equal or better quality than TPS-generated proton plans, and MC-based optimization shows dosimetric advantages for inhomogeneous situations. Concerning TriB-RT, for the academic case, the resulting plan shows substantial contribution of all particle types. For the clinically motivated case, improved sparing of organs at risk close to the target volume is achieved compared to IMPT (e.g. myelon and brainstem [Formula: see text] -37%) at cost of an increased low dose bath (healthy tissue V _10% +22%). In the scenario of a fixed proton beam line, TriB-RT plans are able to compensate the loss in degrees of freedom to substantially improve plan quality compared to a single field proton plan.

CONCLUSION

A novel TPP which simultaneously optimizes photon, electron and proton beams was successfully developed. TriB-RT shows the potential for improved treatment plan quality and is especially promising for cost-effective single-room proton solutions with a fixed beamline in combination with a conventional linac delivering photon and electron fields.

Development of an extended Macro Monte Carlo method for efficient and accurate dose calculation in magnetic fields

MOTIVATION

Progress in the field of magnetic resonance (MR)-guided radiotherapy has triggered the need for fast and accurate dose calculation in presence of magnetic fields. The aim of this work is to satisfy this need by extending the macro Monte Carlo (MMC) method to enable dose calculation for photon, electron, and proton beams in a magnetic field.

METHODS

The MMC method is based on the transport of particles in macroscopic steps through an absorber by sampling the relevant physical quantities from a precalculated database containing probability distribution functions. To enable MMC particle transport in a magnetic field, a transformation accounting for the Lorentz force is applied for each macro step by rotating the sampled position and direction around the magnetic field vector. The transformed position and direction distributions on local geometries are validated against full MC for electron and proton pencil beams. To enable photon dose calculation, an in-house MC algorithm is used for photon transport and interaction. Emerging secondary charged particles are passed to MMC for transport and energy deposition. The extended MMC dose calculation accuracy and efficiency is assessed by comparison with EGSnrc (photon and electron beams) and Geant4 (proton beam) calculated dose distributions of different energies and homogeneous magnetic fields for broad beams impinging on water phantoms with bone and lung inhomogeneities.

RESULTS

The geometric transformation on the local geometries is able to reproduce the results of full MC for all investigated settings (difference in mean value and standard deviation <1%). Macro Monte Carlo calculated dose distributions in a homogeneous magnetic field are in agreement with EGSnrc and Geant4, respectively, with gamma passing rates >99.6% (global 2%, 2 mm and 10% threshold criteria) for all situations. MMC achieves a substantial efficiency gain of up to a factor of 21 (photon beam), 66 (electron beam), and 356 (proton beam) compared to EGSnrc or Geant4.

CONCLUSION

Efficient and accurate dose calculation in magnetic fields was successfully enabled by utilizing the developed extended MMC transport method for photon, electron, and proton beams.

Part 2: Dynamic mixed beam radiotherapy (DYMBER): Photon dynamic trajectories combined with modulated electron beams

PURPOSE

The purpose of this study was to develop a treatment technique for dynamic mixed beam radiotherapy (DYMBER) utilizing increased degrees of freedom (DoF) of a conventional treatment unit including different particle types (photons and electrons), intensity and energy modulation and dynamic gantry, table, and collimator rotations.

METHODS

A treatment planning process has been developed to create DYMBER plans combining photon dynamic trajectories (DTs) and step and shoot electron apertures collimated with the photon multileaf collimator (pMLC). A gantry-table path is determined for the photon DTs with minimized overlap of the organs at risk (OARs) with the target. In addition, an associated dynamic collimator rotation is established with minimized area between the pMLC leaves and the target contour. pMLC sequences of photon DTs and electron pMLC apertures are then simultaneously optimized using direct aperture optimization (DAO). Subsequently, the final dose distribution of the electron pMLC apertures is calculated using the Swiss Monte Carlo Plan (SMCP). The pMLC sequences of the photon DTs are then re-optimized with a finer control point resolution and with the final electron dose distribution taken into account. Afterwards, the final photon dose distribution is calculated also using the SMCP and summed together with the one of the electrons. This process is applied for a brain and two head and neck cases. The resulting DYMBER dose distributions are compared to those of dynamic trajectory radiotherapy (DTRT) plans consisting only of photon DTs and clinically applied VMAT plans. Furthermore, the deliverability of the DYMBER plans is verified in terms of dosimetric accuracy, delivery time and collision avoidance. For this purpose, The DYMBER plans are delivered to Gafchromic EBT3 films placed in an anthropomorphic head phantom on a Varian TrueBeam linear accelerator.

RESULTS

For each case, the dose homogeneity in the target is similar or better for DYMBER compared to DTRT and VMAT. Averaged over all three cases, the mean dose to the parallel OARs is 16% and 28% lower, D2% to the serial OARs is 17% and 37% lower and V10% to normal tissue is 12% and 4% lower for the DYMBER plans compared to the DTRT and VMAT plans, respectively. The DYMBER plans are delivered without collision and with a 4-5 min longer delivery time than the VMAT plans. The absolute dose measurements are compared to calculation by gamma analysis using 2% (global)/2 mm criteria with passing rates of at least 99%.

CONCLUSIONS

A treatment technique for DYMBER has been successfully developed and verified for its deliverability. The dosimetric superiority of DYMBER over DTRT and VMAT indicates utilizing increased DoF to be the key to improve brain and head and neck radiation treatments in future.