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Med. Biol."],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Despite significant dosimetric gains, clinical implementation of the 4\n                    <jats:italic>\u03c0<\/jats:italic>\n                    non-coplanar radiotherapy on the widely available C-arm gantry system is hindered by limited clearance, and the need to perform complex coordinated gantry and couch motion. A robotic radiotherapy platform would be conducive to such treatment but a new conflict between field size and MLC modulation resolution needs to be managed for versatile applications. This study investigates the dosimetry and delivery efficiency of purposefully creating many isocenters to achieve simultaneously high MLC modulation resolution and large tumor coverage. An integrated optimization framework was proposed for simultaneous beam orientation optimization (BOO), isocenter selection, and fluence map optimization (FMO). The framework includes a least-square dose fidelity objective, a total variation term for regularizing the fluence smoothness, and a group sparsity term for beam selection. A minimal number of isocenters were identified for efficient target coverage. Colliding beams excluded, high-resolution small-field 4\n                    <jats:italic>\u03c0<\/jats:italic>\n                    intensity-modulated radiotherapy (IMRT) treatment plans with 50\u2009cm source-to-isocenter distance (SID-50) on 10 Head and Neck (H&amp;N) cancer patients were compared with low-resolution large-field plans with 100\u2009cm SID (SID-100). With the same or better target coverage, the average reduction of [Dmean, Dmax] of 20-beam SID-50 plans from 20-beam SID-100 plans were [2.09 Gy, 1.19 Gy] for organs at risk (OARs) overall, [3.05 Gy, 0.04 Gy] for parotid gland, [3.62 Gy, 5.19 Gy] for larynx, and [3.27 Gy, 1.10 Gy] for mandible. R50 and integral dose were reduced by 5.3% and 9.6%, respectively. Wilcoxon signed-rank test showed significant difference (\n                    <jats:italic>p<\/jats:italic>\n                    \u200a\u2009\u2009&lt;\u2009\u20090.05) in planning target volume (PTV) homogeneity, PTV Dmax, R50, Integral dose, and OAR Dmean and Dmax. The estimated delivery time of 20-beam [SID-50, SID-100] plans were [19, 18] min and [14, 9] min, assuming 5 fractions and 30 fractions, respectively. With clinically acceptable delivery efficiency, many-isocenter optimization is dosimetrically desirable for treating large targets with high modulation resolution on the robotic platform.\n                  <\/jats:p>","DOI":"10.1088\/1361-6560\/ab63b8","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T18:00:32Z","timestamp":1576692032000},"page":"045003","update-policy":"https:\/\/doi.org\/10.1088\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Many-isocenter optimization for robotic radiotherapy"],"prefix":"10.1088","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1835-3870","authenticated-orcid":false,"given":"Qihui","family":"Lyu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Neph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria Y","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3400-7684","authenticated-orcid":false,"given":"Dan","family":"Ruan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salime","family":"Boucher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Sheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"266","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"pmbab63b8bib001","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1120\/jacmp.v16i4.5188","type":"journal-article","article-title":"Single-isocenter hybrid IMRT plans versus two-isocenter conventional plans and impact of intrafraction motion for the treatment of breast cancer with supraclavicular lymph nodes involvement","volume":"8","author":"Amoush","year":"2015","journal-title":"J. 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