A dynamic algorithm for beam orientations in multicriteria IMRT planning

For the last decade, optimization of beam orientations in intensitymodulated radiation therapy (IMRT) has been shown to be successful in improving the treatment plan. Unfortunately, the quality of a set of beam orientations depends heavily on its corresponding beam intensity proles. Usually, a stochastic selector is used for optimizing beam orientation, and then a single objective inverse treatment planning algorithm is used for the optimization of beam intensity proles. The overall time needed to solve the inverse planning for every random selection of beam orientations becomes excessive. Recently, considerable improvement has been made in optimizing beam intensity proles by using multiple objective inverse treatment planning. Such an approach results in a variety of beam intensity proles for every selection of beam orientations, making the dependence between beam orientations and its intensity proles less important. We take advantage of this property to present a dynamic algorithm for beam orientation in IMRT which is based on multicriteria inverse planning. The algorithm approximates beam intensity proles iteratively instead of doing it for every selection of beam orientation, saving a considerable amount of calculation time. Every iteration goes from an N-beam plan to a plan with N + 1 beams. Beam selection criteria are based on a score function that minimizes the deviation from the prescribed dose, in addition to a reject-accept criterion. To illustrate the eciency of the algorithm it has been applied to an articial example where optimality is trivial and to three real clinical cases: a prostate carcinoma, a tumor in the head and neck region and a paraspinal tumor. In comparison to the standard equally spaced beam plans, improvements are reported in all of the three clinical examples, even, in some cases with a fewer number of beams