Technical Note: Improving VMAT delivery efficiency by optimizing the dynamic collimator trajectory.

Purpose: To provide a method for optimizing the multileaf collimator angle trajectory in volumetric modulated arc therapy (VMAT) in order to make VMAT delivery and planning more efficient.
Methods: Static fluence maps are optimized at a 10-degree spacing around the patient. Sliding window delivery time of each of these fields is computed for a large set of possible collimator orientations. An optimal trajectory, which selects a collimator angle for each field and assures that the collimator angles do not differ excessively between adjacent fields, is computed by solving a network flow model of a shortest path problem.
Results: For four clinical cases (two brains, an anal, and a spine), we demonstrate time reductions from 6% to 32% (average: 24%) for the optimal static angle vs the worst static angle. Further reductions from 3% to 17% (average 9%) are achievable when dynamic collimator trajectories are allowed.
Conclusions: Dynamic collimator trajectories, which can be computed with an efficient linear programming formulation, can improve the efficiency of VMAT delivery.
(© 2019 American Association of Physicists in Medicine.)