SU-F-T-333: Deliverability Considerations in Modulated Photon Radiotherapy (XMRT).
PURPOSE
Modulated Photon Radiotherapy (XMRT), which simultaneously optimizes photon beamlet energy (6 and 18 MV) and fluence, has shown dosimetric improvements for fluence map optimization (FMO) when compared to conventional single-energy intensity modulated radiotherapy. However, generating deliverable multi-leaf collimator (MLC) sequences for XMRT needs to be explored. Therefore, two problems were investigated: 1) The ability to generate MLC-sequenced fluence maps from FMO XMRT solutions for a prostate case 2) The impact of fluence smoothening constraints imposed in the FMO on the deliverability and dose distribution.


METHODS
XMRT FMO solutions for a clinical prostate case employing standard dosimetric constraints, prescriptions, and a seven coplanar beam arrangement were generated. Smoothening constraints in the FMO utilized a sum of positive gradients approach. Sequenced maps were generated using an in-house optimization algorithm (MLCSO). The maximum leaf speed, minimum leaf separation, and transmission through MLC leaves were set to 2.5 mm/s, 1 mm, and 1%, respectively. The resulting sequenced maps for each field were compared with the original FMO solutions through gamma analysis (0.5%/0.5 mm) and root mean square error (RMSE). This comparison was done for both the smoothed and unsmoothed XMRT solutions.


RESULTS
Average RMSE and gamma agreement of 0.44, 93%and 0.36, 95% were obtained for unsmoothed 6 and 18 MV contributions from XMRT sequenced maps. The sequenced maps with smoothening constraints had better agreement with their respective optimal fluences, with RMSEs of 0 and gamma pass rates of 100% for all comparisons. This improved smoothening led to increased dose to critical structures (rectum, bladder, and femoral heads); however solutions were still clinically acceptable.


CONCLUSION
For a clinical prostate case, XMRT FMO fluence maps were suitable for conversion into deliverable MLC sequences. Imposing smoothening constraints during FMO resulted in improved sequenced maps, though with a slight increase in dose to the critical structures.