Leaf trajectory calculation for dynamic multileaf collimation to realize optimized fluence profiles

An algorithm for the calculation of the required leaf trajectories to generate optimized intensity modulated beam profiles by means of dynamic multileaf collimation is presented. This algorithm iteratively accounts for leaf transmission and collimator scatter and fully avoids tongue-and-groove underdosage effects. Tests on a large number of intensity modulated fields show that only a limited number of iterations, generally less than 10, are necessary to minimize the differences between optimized and realized fluence profiles. To assess the accuracy of the algorithm in combination with the dose calculation algorithm of the Cadplan 3D treatment planning system, predicted absolute dose distributions for optimized fluence profiles were compared with dose distributions measured on the MM50 Racetrack Microtron and resulting from the calculated leaf trajectories. Both theoretical and clinical cases yield an agreement within 2%, or within 2 mm in regions with a high dose gradient, showing that the accuracy is adequate for clinical application.