[A simple dose-effect model for the optimization of IMRT]. / Einfache Dosis-Effekt-Modelle für die Optimierung in der IMRT.

Optimization of percutaneous photon beams with intensity modulation was investigated in terms of the influence of different dose-effect functions for lung tissue on the resulting dose distributions. The fluence profiles were optimized for a cylindrical phantom with a L-shaped target, the spinal cord and lung presenting the critical organs. Concurrent criteria were a minimum dose constraint for the target and a maximum dose constraint for the spinal cord. The dose effect in the lung was minimized using different approaches. All tested approaches were able to control the dose distribution in the lung. The mean dose remained constant, where as the volume of low dose could be changed. Due to the simplicity of functions and parameters, these models are suitable for clinical implementation.

Application of constrained optimization to radiotherapy planning.

Essential for the calculation of photon fluence distributions for intensity modulated radiotherapy (IMRT) is the use of a suitable objective function. The objective function should reflect the clinical aims of tumor control and low side effect probability. Individual radiobiological parameters for patient organs are not yet available with sufficient accuracy. Some of the major drawbacks of some current optimization methods include an inability to converge to a solution for arbitrary input parameters, and/or a need for intensive user input in order to guide the optimization. In this work, a constrained optimization method was implemented and tested. It is closely related to the demanded clinical aims, avoiding the drawbacks mentioned above. In a prototype treatment planning system for IMRT, tumor control was guaranteed by setting a lower boundary for target dose. The aim of low complication is fulfilled by minimizing the dose to organs at risk. If only one type of tissue is involved, there is no absolute need for radiobiological parameters. For different organs, threshold dose, relative seriality of the organs or an upper dose limit could be set. All parameters, however, were optional, and could be omitted. Dose-volume constraints were not used, avoiding the possibility of local minima in the objective function. The approach was benchmarked through the simulation of both a head and neck and a lung case. A cylinder phantom with precalculated dose distributions of individual pencil beams was used. The dose to regions at risk could be significantly reduced using at least seven ports of beam incidence. Increasing the number of ports beyond seven produced only minor further gain. The relative seriality of organs was modeled through the use of an added exponent to the dose. This approach however increased calculation time significantly. The alternative of setting an upper limit is much faster and allows direct control of the maximum dose. Constrained optimization guarantees high tumor control probability, it is computationally more efficient than adding penalty terms to the objective function, and the input parameters are dose limits known in clinical practice.

Calculation of dose distributions in the vicinity of high-Z interfaces for photon beams.

In the vicinity of interfaces between materials of different atomic number Z, extremes in absorbed dose occur for high-energy photon irradiations. The spatial extension of the effects is within the range of 1 cm, which may not be ignorable from the radiobiological point of view. At the front side of a high-Z slab a maximum is observed, whereas at the exit side a small buildup zone of the dose occurs, e.g., for a 5 MV beam, in front of a water/iron interface, the enhancement is about 30% of that to the homogeneous medium. The reduction at the back of the iron slab is about 16% for this energy, but vanishes with increasing energy. For high-energy photons this effect is mainly caused by the strong atomic number dependence of the scattering power for secondary electrons. The amount and extent of the scattering effects have been measured for aluminum and for iron slabs embedded in water or PMMA. The experimental data are in good agreement with Monte Carlo calculated values. Therefore the data form a reliable base to test the performance of commonly used treatment planning algorithms. The convolution or superposition method is used to calculate dose distributions. To account for the Z dependence of the scattering and the stopping power of the secondary electrons, corrections are applied to the energy deposition kernels. The boundary crossing of energy deposition kernels can be treated only in an approximate manner. However, the algorithm developed improves the accuracy of the dose calculation in the vicinity of interfaces significantly.