Determining leaf trajectories for dynamic multileaf collimators with consideration of marker visibility: an algorithm study

The purpose of this study was to develop a leaf-setting algorithm for Dynamic Multileaf Collimator–Intensity-Modulated Radiation Therapy (DMLC–IMRT) for optimal marker visibility. Here, a leaf-setting algorithm (called a Delta algorithm) was developed with the objective of maximizing marker visibility so as to improve the tracking effectiveness of fiducial markers during treatment delivery. The initial leaf trajectories were generated using a typical leaf-setting algorithm, then the leaf trajectories were adjusted by Delta algorithm operations (analytical computations and a series of matrix calculations) to achieve the optimal solution. The performance of the Delta algorithm was evaluated with six test fields (with randomly generated intensity profiles) and 15 clinical fields from IMRT plans of three prostate cancer patients. Compared with the initial solution, the Delta algorithm kept the total delivered intensities (TDIs) constant (without increasing the beam delivery time), but improved marker visibility (the percentage ratio of marker visibility time to beam delivery time). For the artificial fields (with three markers), marker visibility increased from 68.00–72.00% for a small field (5 × 5), from 38.46–43.59% for a medium field (10 × 10), and from 28.57–37.14% for a large field (20 × 20). For the 15 clinical fields, marker visibility increased 6–30% for eight fields and > 50% for two fields but did not change for five fields. A Delta algorithm was proposed to maximize marker visibility for DMLC–IMRT without increasing beam delivery time, and this will provide theoretical fundamentals for future studies of 4D DMLC tracking radiotherapy.