Optimization by simulated annealing of three-dimensional conformal treatment planning for radiation fields defined by a multileaf collimator

Three-dimensional conformal radiotherapy may be achieved by using a combination of geometrically shaped radiation fields from different orientations around the patient. A convenient method to shape the fields is to use a multileaf collimator. These fields are shaped to the beam's-eye-view of the target volume, at each orientation of the collimator, and may also encompass sensitive structure, i.e. organs at risk, if the target region has concavities in its outline within which such structure may reside. The term 'conformal therapy' is used in this paper to mean tailoring the high dose volume to the target volume whilst minimising dose to other normal structures (organs at risk) which may be irradiated by the treatment fields, shaped by a multileaf collimator. The question then arises of the optimum distribution of beam weights to apply to the fields to minimise dose to organs at risk whilst aiming towards a uniform dose distribution in the target volume. This paper provides a method of optimizing the choice of beamweights to achieve this. The method is based on the well known optimization technique of simulated annealing. Either an optimal set of beamweights, one weight per field, is generated or the intensity may be spatially modulated across the field at each orientation (two weights per field) depending on whether there is just target volume or both target volume and volume containing organs at risk in the line of sight. It is shown that the dose matrix resulting from the latter optimization is closer to the dose prescription than that obtained by using either an optimal set of single weights per field or uniform beamweights.