Implementation and validation of an in-house geometry optimization software for SRS VMAT planning of multiple cranial metastases.

Purpose The implementation and evaluation of an in-house developed geometry optimization (GO) software are described. The GO script provides optimal lesion clustering, isocenter placement, and collimator angle of each arc for cranial multi-lesion stereotactic radiosurgery (SRS) volumetric modulated arc therapy (VMAT) planning. Materials and methods An Eclipse-plugin program was developed to facilitate automatic plan geometry generation for multiple metastases SRS VMAT plans. A mixed, semi-supervised exhaustive and k-means clustering method is used to group lesions and place isocenters. The sum of squared euclidean distance (SSED) and the boundaries of lesions' projection from beams' eye view are used as supervised parameters to determine the optimal isocenter numbers. The collimator angle is optimized by minimizing the sum of the MLC opening area from all gantry angles for each arc. In all, 10 clinical cases treated during 2016-2017 were compared to plan quality of GO script generated plans. Paddick gradient index (GI), conformity index (CI), and local brain volume receiving 12 Gy (local V12 Gy) around each lesion were compared. Result For four cases, the number of isocenters was reduced in the GO plans. For four other cases, the GO plans had the same number of isocenters as their corresponding clinical plans but with different lesion grouping. The GO plans had significantly lower GI (4.1 +/- 1.0 vs 4.4 +/- 0.9,P < 0.0001) and local V12 Gy (5.1 +/- 4.2 vs 5.5 +/- 4.3 in cm(3),P < 0.0001), but not significantly different mean normal brain dose or CI. The volume of normal brain receiving >= 6 Gy was significantly lower in the GO plans. The total time to run the GO script for each case was <2 min. Conclusion The GO software automates lesion grouping, isocenter placement, and the collimator angles for SRS VMAT planning. When tested on 10 cases, the GO script resulted in improved plan quality and shorter planning time when compared to the clinical SRS VMAT plans.