ArticleMedical physics2025
Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy.
Article in Medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Variable-interval temporal feathering to optimize organs-at-risk repair for head and neck adaptive radiotherapy.Physics and imaging in radiation oncology · 2026Article
- Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy.Medical physics · 2025Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRadiotherapy workflows conventionally deliver one treatment plan multiple times throughout the treatment course. Non-coplanar techniques with beam angle optimization or dosimetrically optimized pathfinding (DOP) exploit additional degrees of freedom to improve spatial conformality of the dose distribution compared to widely used techniques like volumetric-modulated arc therapy (VMAT). The temporal dimension of dose delivery can be exploited using multiple plans (sub-plans) within one treatment course. For instance, temporally feathered radiation therapy (TFRT) uses iso-curative sub-plans to deliver an alternance of higher and lower doses compared to a single plan to selected organs-at-risk (OARs), facilitating the dynamic recovery process of healthy tissues. PURPOSE: This study presents a simultaneous optimization framework based on direct aperture optimization with or without DOP to optimize multiple coplanar or non-coplanar sub-plans within one treatment course and demonstrates its use for TFRT planning.
methodsThe goal of the framework was to minimize an objective function consisting of weighted upper or lower dose-volume, generalized equivalent uniform dose, and normal tissue objectives set on the dose distribution of each sub-plan or the combined total plan. Reference VMAT and dynamic collimator trajectory radiotherapy (colli-DTRT) single plans were created and used to derive the objectives for TFRT planning. The TFRT high-to-low dose modulation was integrated into the objective list and systematically investigated for a digital academic phantom using three variations ("soft", "medium", "hard"). Additionally, a "super-soft" variation used the same objectives for all five sub-plans (i.e., no high-to-low dose modulation). Furthermore, "medium" TFRT sub-plans with colli-DTRT were created for three more complex clinically motivated head and neck cases.
resultsFor the phantom, the sub-plans were iso-curative with target D
conclusionA framework for the simultaneous optimization of multiple coplanar or non-coplanar sub-plans within one treatment course was developed. Simultaneous optimization was investigated with a phantom and three clinically motivated cases for TFRT planning. OAR dose modulation in the sub-plans was achieved while increasing target homogeneity and reducing OAR doses in the dose distribution of the total plans compared to the reference plans.
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