Development of a plan complexity mitigation algorithm based on gamma passing rate predictions for volumetric-modulated arc therapy.

Abstract

Volumetric-modulated arc therapy (VMAT) is a complex rotational therapy technique in which highly conformal dose distribution can be realized by varying the speed of gantry rotation, multileaf collimator (MLC) shape, and dose rate. However, the complexity of the technique creates a discrepancy between the calculated and measured doses. Thus, to mitigate the plan complexity in VMAT, this study aimed to develop an algorithm and evaluate its usefulness by conducting a feasibility study. A total of 50 patients who underwent VMAT between September 2015 and December 2020 were arbitrarily selected for this study. Specifically, patients with less than 85% gamma passing rate (GPR) at 5%/1mm or 3%/2mm criterion were selected randomly. Using the GPR prediction model, problematic MLC positions that contribute to a decrease in GPR were identified. Those problematic MLC positions were optimized using a limited nonlinear algorithm under mechanical limitations. Additionally, the dose prescription for the target was re-normalized. The VMAT modulated complexity score (MCSv ), averaged aperture area (AA), and monitor unit per gray (MU/Gy) were evaluated as plan complexity parameters. Calculated doses in patient geometry were evaluated for the target and its surrounding region. In addition, an ArcCHECK cylindrical diode array was used to measure the dose, and GPRs at 5%/1mm and 3%/2mm criteria were evaluated to analyze the difference between the mitigated and original plans. The difference was calculated using the mean±standard deviation. The differences between the MCSv , AA, and MU/cGy values for the mitigated and original plans were 0.8±1.7 (×10-2 ), 42.7±57.9, and -5.6±8.5, respectively. Regarding the calculated dose, the dose volume parameters were consistent within 1% for the target and the surrounding region. The differences between the mitigated and original plans were 1.8±2.9% and 1.3±1.8% for GPRs at 5%/1mm and 3%/2mm, respectively. This feasibility study resulted in the development of an algorithm with the potential to mitigate plan complexity and improve the GPR for VMAT under minor leaf position modifications.