Dynamic Trajectory-Based Couch Motion for Improvement of Radiation Therapy Trajectories

Abstract

This work investigates potential improvement in external beam radiation therapy plan quality using an optimized dynamic gantry and patient support couch motion trajectory, which could minimize exposure to sensitive healthy tissue. Anonymized patient anatomy and treatment plans of cranial cancer patients were used to quantify the geometric overlap between planning target volumes (PTVs) and organs-at-risk (OARs) based on their two-dimensional projection from source to a plane at isocentre as a function of gantry and couch angle. Published dose constraints were then used as weighting factors for the OARs to generate a map of couch-gantry coordinate space, indicating degree of overlap at each point in space. A couch-gantry collision space was generated by direct measurement on a linear accelerator and couch using an anthropomorphic solid-water phantom. A dynamic, fully customizable algorithm was written to generate a navigable ideal trajectory for the patient specific couch-gantry space. The advanced algorithm can be used to balance the implementation of absolute minimum values of overlap with the clinical practicality of large-scale couch motion and delivery time. Optimized cranial cancer treatment trajectories were compared to conventional treatment trajectories. Comparison of optimized treatment trajectories with conventional treatment trajectories indicates an average decrease in mean dose to the OARs of 19% and an average decrease in max dose to the OARs of 12%. Our study indicates that simultaneous couch and gantry motion during radiation therapy to minimize the geometrical overlap in the beams-eye-view of target volumes and the organs-at-risk can have an appreciable dose reduction to organs-at-risk.