Intensity modulation of therapeutic photon beams using a rotating multileaf collimator (2004)

The thesis describes the development and implementation of a novel method of delivering intensity modulated radiation therapy (IMRT) that provides greater accuracy and spatial resolution than currently available methods. Through improvements in multileaf collimator (MLC) based fluence generation, a dose distribution may be generated that conforms more closely to the tumour target volume. Healthy tissue surrounding the target volume will therefore receive less dose, reducing the probability of side effects and allowing the physician to increase the prescribed tumor dose (dose escalation). As a preamble to the description of the IMRT delivery method a new model for evaluating the spatial resolution capabilities of dose delivery techniques is presented. Flexibility and complexity in patient treatment due to advances in radiotherapy techniques necessitates a simple method for evaluating spatial resolution capabilities of the dose delivery device. The model is based on linear systems theory and is analogous to methods used to describe resolution degradation in imaging systems. The spatial resolution capabilities of different delivery components can be quantified separately, providing a simple method for comparing different treatment machine characteristics. Also, the model provides the ability to evaluate spatial resolution changes independent of the tumor that is being treated, providing a means of comparing delivery techniques that is not biased by the characteristics of any particular treatment volume. MLC based IMRT techniques are well established but suffer several physical limitations. Dosimetric spatial resolution is limited by the MLC leaf width, interleaf leakage and tongue-and-groove effects degrade dosimetric accuracy and the range of leaf motion limits the maximum deliverable field size. Based on observations from the linear systems model it is hypothesized that, by rotating the entire MLC between each sub-field, improvements will be obtained in spatial resolution, dosimetric accuracy and maximum deliverable field size. To generate arbitrary fluence maps in this way, a series of unique algorithms were developed that are capable of determining the necessary rotated MLC segments. These IMRT fields may be delivered statically (with the collimator rotating to a new position in between sub-fields) or dynamically (with the collimator rotating and leaves moving simultaneously during irradiation). A full description of the rotational leaf motion algorithms is provided. An analysis of the rotating leaf motion calculation algorithms with focus on radiation efficiency, the range of collimator rotation, and number of segments is provided. The mechanical and radiation producing characteristics of standard linear accelerators under collimator rotation conditions are also investigated. The technique is evaluated by characterizing the ability of the algorithms to generate rotating leaf sequences for desired fluence maps. Comparisons are also made between our method and conventional sliding window and step-and-shoot techniques. Results show improvements in spatial resolution, reduced interleaf effects, and maximum deliverable field size over conventional techniques. Clinical application of these enhancements can be realized immediately with static rotational delivery although improved control of the MLC will be required for dynamic delivery.