Smoothing intensity-modulated treatment delivery under hardware constraints.

A method is developed to smooth intensity-modulated beam delivery while considering hardware constraints. The method uses matrix algebra to model MLC leaf motion and hardware constraints such as interleaf digitization, synchronization requirements, and intersegment field abutment to deliver intensity modulated beam sequences. It was implemented and demonstrated for simulated and clinical intensity modulated cases. The simulated cases included intensity distributions from 3 x 3 to 30 x 30 in dimension with 1,000 intensity levels. The clinical examples included four treatments sites: prostate, head and neck, lung, and esophagus cancers. In particular, we studied the relationships between the intensity levels, segment numbers and their influence on the dose-volume histograms of the inversely optimized IMRT treatment plans. It was found that a significant reduction in the leaf segment numbers was achieved by applying the smoothing approach. The effects were found to be more significant for the unconstrained delivery than for the constrained delivery. The effects were also found to be more sensitive for the complex intensity distributions such as the head-and-neck cases than for the less complex ones such as the prostate cases. These results demonstrated the feasibility of maintaining inversely optimized treatment plans under acceptable tolerance levels while smoothing IMRT treatments with hardware constraints.