Impact of the number of control points has on isodose distributions in a dynamic multileaf collimator intensity-modulated radiation therapy delivery

Intensity-modulated radiation therapy (IMRT) is a powerful technique in planning the delivery of dose. The most common IMRT delivery requires the use of moving multileaf collimators (MLCs) to deliver the requested fluence pattern. A dynamic delivery IMRT field file will contain several control points that are defined MLC shapes at a marked fraction of the delivered monitor units. The size of this file and the fidelity of the deliverable fluence are proportional to the number of control points defined. This study investigates the effect of reducing the number of control points has on the resultant dose distribution quality in complex IMRT in efforts to reduce transfer times, loading times, check sum times and file storage. Analysis was performed with 6 head and neck patients on an Eclipse version 8.5 treatment planning system (Varian, Palo Alto, CA). To ensure the quality of all treatments, Eclipse defines a minimum of 64 and a maximum of 320 control points per subfield (Eclipse Algorithms Reference guide). All 6 patients' plans were calculated with fixed 64, 166, and 320 control points using the sliding window technique. In addition, each plan was calculated in variable mode (Normal mode) in which the planning system determined the required number of control points. Each of the 4 plans for each patient was renormalized to provide the same mean planning target volume (PTV) 70 dose. Dose values for critical and target structures were examined for each patient. When examining the minimum, maximum, and mean doses to all target structures, it was noted that the greatest reduction in target dose coverage caused by reduced number of control points was 0.5%, which occurred for the minimum dose to the PTV56 structure in one plan." Dose analysis for critical structures showed no clinically significant increase in dose when compared with the 320 control point plan.