Configuration options for intensity-modulated radiation therapy using multiple static fields shaped by a multileaf collimator. II: constraints and limitations on 2D modulation.

This paper addresses the technique of using multiple static multileaf-collimator-shaped field components to create a two-dimensional intensity-modulated beam (2D IMB). It addresses the physical constraints on the problem of determining the optimum field-component leaf configurations under the circumstances that (i) the static field components are shaped by leaves alone and (ii) the 2D intensity distribution is delivered by exactly N field components when there are N rising-intensity equal-fluence increments in the 1D channel containing the maximum fluence in the 2D IMB. This corresponds to the least inefficient delivery. In general it is noted that an optimum solution (set of field-component leaf configurations) with zero tongue-and-groove underdose may not exist (depending on the distribution) and an exhaustive search for the set of leaf configurations with the minimum tongue-and-groove underdose is impossible for realistically sized problems. Against this background iterative methods to examine a limited search space are shown to yield an optimum solution with zero tongue-and-groove underdose for certain intensity distributions. These searches are not robust and can be defeated. The problem of finding an optimum solution may be generally insoluble for some 2D IMBs under the conditions (i) and (ii). If, however, a larger number of field components is permitted and/or the accelerator jaws may also be used, in addition to the multileaves, then an optimum solution with zero tongue-and-groove underdose can always be found with lower efficiency.