TH-EF-BRB-07: Novel Hardware and Software Platform for Intermediate Energy 4π Radiotherapy




To develop a robust and efficient platform for the optimization and robotic delivery of highly noncoplanar intensity modulated radiotherapy, which enables significant reduction of normal tissue toxicity and escalation of tumor dose.


An innovative high-output compact 3 MV linac was designed for mounting onto a commercial robotic system in order to access the entire 4π beam solution space without moving the patient couch. The use of intermediate energy X-rays for radiotherapy was evaluated in comparison to clinical plans delivered using 6 MV X-rays and a state-of-the-art delivery system. Monte Carlo simulations of a 3 MV percent depth dose curve were performed for intermediate energy dose calculation. The beam model was used to create a convolution/superposition-based dose calculation engine for 3MV X-rays. The 4π greedy column generation algorithm was used for optimized beam selection and fluence map optimization.


A detailed design of the first 3 MV linac capable of producing a competitively high dose rate of >800 cGy/min at 100 cm was completed and verified through extensive simulation. The complete linac head including a multileaf collimator can access most of the 4π solution space including the posterior orientations without changing the couch height. When compared to 6 MV clinical plans, the proposed 3 MV 4π plans demonstrated significantly better dose compactness and normal tissue sparing in brain, prostate, and partial breast treatment plans.


We demonstrate the design of a highly versatile radiotherapy machine to natively deliver non-coplanar 4π radiotherapy without the need to move the patient during treatment. This novel platform is efficient and capable of providing dosimetry that is 30–50% more compact than existing therapy platforms. The new system is projected to be cost effective due to improved treatment time and automation.

NIH R43CA183390, NIH R01CA188300