VARIAN MEDICAL SYSTEMS WH ITE PAPER BEAM ANGLE OPTIMIZATION

Beam Angle Optimization (BAO)

A White Paper

Version: 0.3
Date: October 5, 2007
Author: Katja Pesola
TABLE OF CONTENTS

Introduction 2
Description of Plan Geometry Optimizer (PGO) 2
Global optimization mode
Initial field geometries
Removing forbidden fields from the initial field distribution
The final number of fields in the plan
Number of fluence optimization iterations per global
geometric iteration
Field reduction
Field number constraint
Lateral inhibition
Proximity effect
Minimum field separation angle
Initial field removal effects

Local optimization mode

Number of fluence optimization iterations per local
geometric iteration
Initialization phase
Optimization phase
Additional stopping criteria

Normal Tissue Objective (NTO) 10

NTO shape

Appendix A: Input parameters for PGO 12

List of PGO input parameters
Use of PGO input parameters
Introduction
The goal of beam angle optimization in external radiation therapy is to find an opti-
mal positioning of incident treatment beams. The optimality of a treatment plan is
usually defined in terms of a prescribed, homogeneous dose delivered to the Planning
Target Volume (PTV). Simultaneously, the dose to the surrounding normal tissue,
especially to the sensitive Organs At Risk (OARs), should be minimized.

Intensity-modulated radiotherapy (IMRT) is a powerful technology for produc-

ing highly three-dimensionally conformal dose distributions to the PTV, while spar-
ing OARs and normal tissue as much as possible. The conventional IMRT planning
starts with the selection of suitable beam angles followed by an optimization of beam
profiles (intensity matrices) using inverse optimization methods in order to minimize
the value of an objective function (OF). Typically, the value of OF is proportional to
the fulfillment of the user-given dose-volume histogram (DVH)-based objectives for In order to speed up the planning
PTV and for OARs. Currently, the selection of beam angles is generally based upon process for IMRT treatments and
the experience of the human planner. Several trial-and-error attempts are normally to provide the user with an auto-
needed in order to find a group of acceptable beam angles, prolonging the time matic tool for selecting optimal
required for treatment planning up to several hours. beam angles, an algorithm for
In order to speed up the planning process for IMRT treatments and to provide beam angle optimization in IMRT
the user with an automatic tool for selecting optimal beam angles, an algorithm for was developed...
beam angle optimization in IMRT was developed at Varian Medical Systems
Finland Oy (VMSFi). The beam angle optimization algorithm is based on the
beam profile (fluence) optimization algorithm used in the Inverse Planning module
inside the Eclipse Treatment Planning System. The algorithm is supposed to be
run before the optimization of fluences to be delivered during the IMRT treat-
ment. The same DVHbased objectives can be used both in fluence optimization
and in beam angle optimization. The goodness of the optimization results is meas-
ured from the OF value, which is proportional to the fulfillment of the objectives.
Hereafter, the beam angle optimization algorithm in the Eclipse Treatment
Planning System shall be called Plan Geometry Optimizer (PGO).

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The beam angle optimization
iterations are continued until
the desired number of fields has
been reached.
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Description of Plan Geometry Optimizer (PGO)
PGO may be run in two operating modes: the global optimization mode and the
local optimization mode. In the global mode, either a 2D (coplanar) or a 3D (non-
coplanar) search space may be used. The initial search space is covered with a preset
number of uniformly distributed fields. Thereafter, a few fluence optimization itera-
tions are calculated in order to produce an optimal beam profile for each field.
Throughout the optimization process, the 3D dose distribution is completely calcu-
lated in order to fully account for long range scatter effects. The relative importance
of each field is determined by removing the field from the plan and calculating the
corresponding OF value. The fields with a low importance value are thereafter
removed. The beam angle optimization iterations are continued until the desired
number of fields has been reached. There is also a possibility to optimize the final
number of fields to be left in the plan.
The local beam angle optimization mode is used for locally expanding the initial-
ly discrete search space into a continuous one. The field parameters are modified
within a local environment in order to minimize the value of the objective function.
Global optimization mode
The global beam angle optimization mode in PGO starts with a large initial number
of fields either in a coplanar (2D) or in a non-coplanar (3D) geometry. The PGO
algorithm uses a fixed isocenter, i.e., all the fields in the initial field distribution have
the same isocenter. The isocenter is copied from the first field in the field list. After
the initial field geometry has been created, a few fluence optimization iterations are
calculated. After the optimization of fluences, each field is separately removed from
the plan. The effect of removing each of the fields separately is evaluated by calculat-
ing the corresponding OF value. The fields, which removal causes the smallest
increase in the value of the objective function, can be considered to be less impor-
tant. Therefore, these fields are removed from the field geometry. These beam angle
optimization iterations, during which the fluences are optimized and thereafter bad
fields removed, are then continued until the desired number of fields in the final plan
has been reached. It is also possible to let PGO decide the optimal number of fields
in the final plan.
Initial field geometries
The geometry of the initial field configuration can be controlled with a parame-
ter value. The initial field distribution in global optimization may be one of
the following:
1. Coplanar (2D)
2. Non-coplanar (3D)
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 Selecting the coplanar geometry creates a 2D initial field distribution, where
the couch angles are set to zero. The fields are generated equally spaced with an
increasing value for the gantry angle. Selecting the non-coplanar geometry creates a
3D initial field distribution, where the field directions are equally distributed in
3D space so that the angle to the closest field would be approximately the same for
all fields. Opposing fields are avoided in the non-coplanar field geometry. The ini-
tial number of fields both in the coplanar and in the non-coplanar field geometry
is controlled with a parameter value. The maximum initial number of fields is 400.

There is also a possibility to specify a limit value for collimator angle separation
in adjacent fields. If this value is set to zero, the collimators will not be rotated and
are left at zero degree (IEC). If the limiting value for collimator angle separation is
set to 180 degrees, or larger, the x-direction of the MLC (the movement direction
of the leaves) will coincide with the shortest dimension of the PTV in the BEV.

There is a possibility to use an offset for the gantry angles in the co-planar field
geometry. This offset is mainly intended for research purposes. It can be used in
sensitivity analysis of the algorithm. The amount of the offset (in degrees) can be
controlled by a parameter value.

In case the non-coplanar field geometry is used, there is a possibility to give a

limiting value for the elevation angle of the fields from the coplanar plane. The fields
in the initial field distribution will not have elevation angle values larger than the
specified limit.

Removing forbidden fields from the initial field distribution

The initial field distribution may contain fields which cannot be used in dose cal-
culations. Also, it might be impossible to deliver some fields due to the physical
limitations of the treatment machine in creating certain gantry and /or couch rota-
tions. In order to perform beam angle optimization only for valid fields, the fol-
lowing fields are excluded from the initial field distribution:
Fields going in through the end(s) of the CT stack
After the creation of the initial field distribution fields entering the patient through
either ends of the CT stack are removed from the initial field distribution.
Fields with forbidden gantry / couch angle combinations
It is possible to define forbidden gantry / couch angle combinations using a config-
uration file. If such a file does not exist when PGO is being run, it is automatically
created. If the file already exists, the information in it is used by PGO. This file
can be edited in order to give individual specifications for forbidden gantry / couch
angle combinations.

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 The final number of fields in the plan

The final number of fields which shall be left in the treatment plan after global
beam angle optimization is controlled with the following two parameter values:

1. Minimum number of fields

2. Maximum number of fields

If the minimum number of fields equals the maximum number of fields, the
specified number of fields will be left in the final plan.

If the minimum number of fields is less than the maximum number of fields,
the final field geometry will have an optimal number of fields which belongs to the
specified range. The optimal number of fields is determined from the value of the
objective function in the following way: if the value of the objective function
increases due to the removal of fields, the removal shall be canceled and the value
of the field reduction rate shall be reduced to one half of the original value.
Thereafter, the beam angle optimization iteration is re-calculated with the reduced
field reduction rate. This procedure is continued until either 1) a decreased value
of the objective function is obtained, and fields are removed according to the cur-
rent field reduction rate, or 2) the removal of the fields is canceled and global
beam angle optimization stops.

The effect of the number of fields on the objective function is adjusted with the
field number constraint (see Fig. 1).

Number of fluence optimization iterations per global geometric iteration

The number of fluence optimization iterations, which are run during one beam
angle optimization iteration in the global optimization mode, is controlled with
a parameter value. It is recommended to use at least three fluence iterations per
global geometric iteration.

Field reduction

The number of fields to be removed at the end of global beam angle optimization
iteration is controlled by the Field Reduction Rate (FRR) parameter. The number
of fields to be removed is calculated as

nremoved = FRR*( nleft-nmin ), (1)

where nremoved is the number of fields to be removed, nleft is the number of fields
which are currently included in the plan and nmin is the minimum number of
fields to be left in the final plan. Thus, the global optimization mode in PGO aims
at leaving nmin fields in the plan.

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Field number constraint

To control the number of fields to be left in the final plan, a constraint has been
added into the calculation of the objective function. The reason for this is that if
fields are removed from the plan, the value of the objective function used in flu-
ence optimization typically increases. An increase in the value of the objective
function would not allow the removal of the fields, and a large number of fields
would be left in the final plan. The constraint used in restricting the number of
fields in the final plan is called the field number constraint, and its shape is pre-
sented in Fig. 1.

Figure 1. The shape of the field number constraint.

With the field number constraint, the number of fields in the final plan is con-
strained into values typically below 10. The strength of the constraint is adjusted
with a weight parameter.

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 Lateral inhibition

To prevent the algorithm from removing all the fields from a bad direction during
the first global beam angle optimization iterations, a calculation called lateral inhi-
bition is implemented in the algorithm. Lateral inhibition enhances the values of
the objective function near the removed fields. Due to the inhibition, fields located
close to removed fields have an increased objective function value and therefore
tend to be left in the plan. The calculation of lateral inhibition is cumulated in the
values of the objective function within one beam angle optimization iteration. The
effect of lateral inhibition is reset when the next beam angle optimization iteration
starts. The shape of the lateral inhibition function (LI) is a linear combination of
cosine powers:

LI = C* ( cos2.5 + cos18 )*std, (2)

where C is the value of the weight parameter used to control the amount of lateral
inhibition, is the angle to the removed field and std is the standard deviation of
the field removal effects. The shape of the lateral inhibition function with std = 1 is
presented in Fig. 2.

Figure 2. The shape of the lateral inhibition function.

The values of the objective function (OF) are then updated with the lateral inhibi-
tion in the following way:

OFnew = OFold + LI. (3)

Thus, the importance of the fields located close to removed field is increased with
respect to the remaining fields.

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Proximity effect

Sometimes beam angle optimization results in plans which have fields located close
to each other. This situation in a final treatment plan is usually regarded as unde-
sirable because it can easily produce hot spots in the normal tissue. To avoid
closely located fields in the final treatment plan, a calculation called proximity
effect is available in PGO. The proximity effect is calculated in a similar way as lat-
eral inhibition but in this case, is the angle to the closest field in the plan. The
weight for the proximity effect calculation is adjusted with a parameter value. The
amount of the proximity effect is then subtracted from the original values of the
objective function in order to decrease the importance of fields located close to
each other.

Minimum field separation angle

Another mechanism available for excluding fields, which are close to one another,
is implemented in terms of setting a limiting value for the angle how close the
fields are allowed to stay in the final field configuration. The value for the limiting
angle can be controlled by a parameter value.

Initial field removal effects

The values of the field removal effects calculated during the first beam angle opti-
mization iteration are preserved for further use. These values are assumed to con-
tain information about the geometry of the patient, which is then lost during the
following beam angle optimization iterations. The initial field removal effect values
can be included in the following beam angle optimization iterations by adding
their weighted value into the current values of the objective function. The weight
given to the initial field removal effects can be adjusted with a parameter value.

Local optimization mode

In addition to the global beam angle optimization, there is a local beam angle opti-
mization mode available in PGO. Opposite to the global mode, the local beam
angle optimization mode modifies the beam angle parameters of an existing treat-
ment plan. No fields are added to or removed from the plan. In the local beam
angle optimization mode, there are two algorithms available for optimizing of the
field parameters: 1) the downhill Simplex method and 2) the Powell method.
Opposite to the global mode, the
Information about the two optimization methods can be found in Numerical
local beam angle optimization
Recipes in C: The Art of Scientific Computing (William H. Press, et al.). The parame-
mode modifies the beam angle
ters to be optimized are the gantry angles in the coplanar case, and the gantry and
parameters of an existing
the couch angles in the 3D non-coplanar case. The collimator angles are also calcu-
treatment plan.
lated if the limiting value for the collimator angle separation in adjacent fields is
larger than zero. Throughout the local optimization mode the information about
the best field configuration found so far is stored. Therefore, this information is
always available if the local optimization mode is stopped at any time.

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 Number of fluence optimization iterations per local geometric iteration

The Simplex and the Powell methods require only objective function evaluations,
not derivatives. The number of fluence optimization iterations to be run within
each local geometric optimization iteration can be controlled by a parameter value.

Initialization phase

Simplex algorithm
In the initialization phase of the Simplex algorithm, the corner points of the original
simplex are generated. The number of corner points is N + 1 where N is the number
of parameters to be optimized, i.e., the gantry angles in the 2D case and the gantry
and couch angles in the 3D case. The generation of each corner point requires a cal-
culation of the objective function. The distance from each corner point to the start-
ing point, i.e., the amount of change applied to each parameter in the construction
phase of the simplex, is controlled by a parameter value. This value is common for
gantry and couch angles.
Powell algorithm
The Powell algorithm calculates line minimizations along the specified search direc-
tions. The search directions are initialized with unit vectors. Thus, in the first Powell
iteration each parameter is optimized separately. The initial step size is controlled
with the same parameter value as is used for the Simplex algorithm. The search space
for each parameter is expanded until there is a minimum point found between the
line end points.

Optimization phase

Simplex algorithm
After the construction of the original simplex, the corner points are modified
according to the algorithm schema. The procedures included in finding a new cor-
ner point for the simplex are called a Simplex iteration. In the beginning of a
Simplex iteration the stopping criteria for the algorithm are checked first. If none
of the criteria are met, the algorithm continues by finding a new position for the
worst corner point in the simplex. If there is no improvement found in the value of
the objective function, the Simplex algorithm stops.
Powell algorithm
After initializing the search directions with unit vectors, the Powell algorithm pro-
ceeds according to the algorithm schema by finding so called conjugate search direc-
tions. The calculations performed during the line minimizations along the current
search directions are called a Powell iteration. In the beginning of Powell iteration,
the stopping criteria for the algorithm are checked first.

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Additional stopping criteria
In addition to the condition discussed in the previous section, there are three addi-
tional stopping criteria used in the local optimization mode. These criteria are pre-
sented in the following sections.

Number of objective function calculations

The maximum number of objective function calculations, i.e., the number of local
optimization iterations, can be used as a stopping criterion in the local optimization
mode. This parameter is included in the list of input parameters for PGO. However,
it is not recommended to set a low value for this number since the algorithm may
not have reached a minimum point if the execution is stopped too early.

In the Powell algorithm, the number of calculated local optimization iterations

is checked only in the beginning of Powell optimization iteration, not during the
iteration. Therefore, the total number of local optimization iterations may exceed
the given input parameter value.

Convergence of the algorithm

This stopping criterion is used only for the Simplex algorithm.

The convergence of the algorithm is checked in the beginning of a Simplex

iteration. If there are no significant changes detected in the value of the objective
function during recent iterations, the Simplex algorithm shall be stopped.

The evaluation of the convergence is controlled by two parameter values: the

number of Simplex iterations to be included in the evaluation, and the limit value
for the amount of change in the value of the objective function which determines
whether the optimization shall be continued. Currently, these parameters do not
belong to the list of PGO input parameters.

Invalid field parameters

Depending on the properties of the patient geometry and/or on the definition of the
valid gantry and couch angles, valid field parameters may not be found in generating
new field directions in the local optimization mode. If valid field parameters cannot
be found after a certain number of trials, the local optimization mode stops.

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 Normal Tissue Objective (NTO)
Since giving values for the plan goals to be used inside beam angle optimization is
crucial for the success of the optimization, a new type of objective was developed
for the part of the body which is not included in the PTV(s). In this document,
this part of the body shall be called normal tissue. The new objective is called
Normal Tissue Objective (NTO). It was developed in order to take into account
the desired decrease in the dose level as the distance from the PTV(s) is increased.
In addition to beam angle optimization, NTO may be used in fluence optimiza-
NTO is expected to limit dose
tion. NTO is expected to limit dose level in the healthy tissue in a physical man-
level in the healthy tissue in a
ner. The use of NTO with proper parameter values should remove possible hot
physical manner.
spots in the healthy tissue.

NTO shape
The shape of NTO is controlled with the following parameters:

Distance from PTV border ( xstart )

Start dose ( 0 )
End dose ( )
Fall-off ( k )

The shape of NTO ( (x) ) as a function of the distance from PTV border ( x )
is calculated according to the following formula:

(4)

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 A typical shape for NTO is presented in Fig. 3.

Figure 3. An example of the shape of the normal tissue objective.

The shape of NTO presented in Fig. 3 has been calculated with the following
parameter values: xstart = 10 mm, 0 = 1.0, = 0.5 and k = 0.05.

The normalization of NTO is done in the following way: the level 1.0 (or 100
%) is selected to correspond to the lowest upper objective of the target. If no upper
objective is set to the target, the level 1.0 (or 100 %) is selected to be 1.05 times the
highest lower objective of the target. If there are several targets in the plan, the NTO
is first calculated for each target and at each body point; the largest of all calculated
NTO values is kept to define the total NTO. The NTO has no value inside any of
the targets in a plan.

In addition to the four parameters which control the shape of NTO, its relative
importance with respect to the other objectives used in optimization can be con-
trolled with a priority parameter in a similar way than for the DVH objectives.

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 Appendix A: Input parameters for PGO
This section contains information about the input parameters which are used in
the PGO algorithm to control the execution.

List of PGO input parameters

The input parameters for the PGO algorithm are listed in Table 1. The table also
includes their types, valid ranges and default values.

Table 1. Input parameters for PGO.

Parameter name Type Valid range Default value

Initial field distribution String Coplanar, Coplanar
Non-coplanar,
None
Initial number of fields Int 2 - 400 71
Minimum number of fields Int 2 - 15 5
Maximum number of fields Int 2 - 15 9
Maximum collimator variation [deg] Double 0 180 0
Coplanar offset angle [deg] Double 0 90 0
Maximum elevation angle for non-coplanar fields [deg] Double 0 90 90
Fluence iterations per global geometric iteration Int 1 - 20 3
Field reduction rate Double 0 - 1 0.5
Field number constraint weight Double 0 - 1 0.4
First global iteration weight Double 0 - 1 0.1
Lateral inhibition weight Double 0 - 1 0.4
Proximity effect weight Double 0 - 1 0.4
Minimum field separation angle [deg] Double 0 - 90 10
Local geometric optimization mode String Simplex, Simplex
Powell, None
Fluence iterations per local geometric iteration Int 1 - 20 3
Maximum number of local optimization iterations Int 0 - 500 40
Initial step size in local optimization [deg] Double 1 - 180 10

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Use of PGO input parameters
This section describes the effect of the input parameter values on the execution
of PGO.

Initial field distribution

There are three possible choices for the initial field distribution: Coplanar, Non-
coplanar and None. The coplanar and non-coplanar initial field geometries shall be
created as explained earlier. Selecting None as the initial field distribution shall skip
the global optimization phase. In this case, the active plan in Eclipse shall be used
as the input plan for local optimization.

Initial number of fields

This parameter shall set the initial number of fields in the field geometry to be cre-
ated for global optimization. However, the field geometry shall be checked before
running global optimization. The check includes removing the fields which enter
the patient through the end(s) of the CT stack and / or the fields with forbidden
gantry / couch angle values. Therefore, the actual number of fields left in the initial
field distribution after the validity check may be less than the number specified by
this parameter.

Minimum number of fields

This parameter shall set the lower limit for the number of fields to be left in the
plan after running global beam angle optimization.

Maximum number of fields

This parameter shall set the upper limit for the number of fields to be left in the
plan after running global beam angle optimization.

Maximum collimator variation

This parameter shall control how much the collimator angle values are allowed to
vary from one field to the closest neighboring field in the initial field distribution.
If this value is set to zero, the collimators shall not be rotated but are left to zero
angle. If the limiting value for collimator angle separation is set to 180 degrees, the
collimators shall be rotated between 270 degrees (i.e., -90 degrees) and 90 degrees
so that the x-direction of the MLC (the movement direction of the leaves) shall
coincide with the shortest dimension of the PTV in the BEV. This choice aims at
the minimum number of carriage groups required for the treatment. In most cases,
it also results in minimizing the area of healthy tissue inside the collimator jaws. If
a value smaller than 180 degrees is selected, the collimator angles of neighboring
fields shall stay within the specified limit. Within the limit, the movement direc-
tion of the leaves shall coincide with the shortest dimension of the PTV.

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 Please note that currently the individual machine limits for collimator angle
rotation are not taken into account by PGO. Constraining the collimator
angle values between 270 and 90 degrees is considered strict enough for most
linear accelerators.

Coplanar offset angle

In case of a coplanar initial field distribution, the offset to the starting gantry angle
(default = 0 degrees) can be adjusted with this parameter value. It shall not have
any effect on the non-coplanar initial field distribution.

Maximum elevation angle for non-coplanar fields

This parameter shall control the maximum elevation from the coplanar plane in
case a non-coplanar initial field distribution is being used.

Fluence iterations per global geometric iteration

This parameter shall set the number of fluence optimization iterations to be run
within global beam angle optimization iteration.

Field reduction rate

This parameter shall control the number of fields to be removed from the plan
after global beam angle optimization iteration. If the value is increased, the number
of fields to be removed is increased, and the execution of the algorithm shall be
faster. However, it is not recommended to increase this value above 0.5.

Field number constraint weight

This parameter shall control the cost for leaving more fields in the final plan. See
section Description of PGO Global optimization mode Field number constraint
for further details.

First global iteration weight

See section Description of PGO Global optimization mode Initial field removal
effects for description of the use of this parameter.

Lateral inhibition weight

See section Description of PGO Global optimization mode Lateral inhibition for
the description of the use of this parameter.

Proximity effect weight

See section Description of PGO Global optimization mode Proximity effect for
description of the use of this parameter.

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Minimum field separation angle

This parameter shall control how close to each other the fields are allowed to stay
in the final plan after running global optimization. It shall also apply in the local
optimization mode.

Local geometric optimization mode

This parameter shall set the mode for local beam angle optimization. Possible
choices are to skip the local optimization (None), or to use Simplex or Powell
optimization methods.

Fluence iterations per local geometric iteration

This parameter shall set the number of fluence optimization iterations to be run in
local beam angle optimization iteration.

Maximum number of local optimization iterations

This parameter value shall set the upper limit for the number of objective function
evaluations to be calculated within the local optimization mode. Therefore, it shall
control the execution time spent in local beam angle optimization. See section
Description of PGO Local optimization mode Additional stopping criteria
Number of objective function calculations for further details.

Initial step size in local optimization

This parameter value shall set the initial distance between the original and the new
(trial) field direction in the local optimization mode. This parameter value shall be
used by Simplex optimization and by Powell optimization.

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