The efficient delivery of intensity modulated radiation therapy (IMRT) depends on finding optimized beam intensity patterns that produce dose distributions, which meet given constraints for the tumor as well as any critical organs to be spared. Many optimization algorithms that are used for beamlet-based inverse planning are susceptible to large variations of neighboring intensities. Accurately delivering an intensity pattern with a large number of extrema can prove impossible given the mechanical limitations of standard MLC delivery systems. In this study, we apply Cimmino's simultaneous projection algorithm to the beamlet-based inverse planning problem, modeled mathematically as a system of linear inequalities. We show that using this method allows us to arrive at a smoother intensity pattern. Including non-linear terms in the simultaneous projection algorithm to deal with dose-volume histogram (DVH) constraints does not compromise this property from our experimental observation. The smoothness properties are compared with those from other optimization algorithms which include simulated annealing and gradient descent method. The simultaneous property of these algorithms is ideally suited to parallel computing technologies.
Physics in Medicine and Biology, Vol. 49 (2004), pp. 3227-3245.