• Christopher M Lee, Gordon A Watson, and Dennis D Leavitt.
• Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Latter-Day Saints Hospital, Salt Lake City, Utah, USA.
• Neurosurg Focus. 2005 Jul 15; 19 (1): E12.

ObjectThe purpose of this study was to determine the effect of static and dynamic collimator optimization when using a micromultileaf collimator (mMLC) in dynamic-arc stereotactic radiosurgery (SRS) by evaluating the dose to healthy peritumoral tissue.MethodsThirty patients previously treated for intracranial lesions with the BrainLAB mMLC underwent retrospective replanning. Three collimator optimization strategies were compared for a simulated SRS treatment plan, as follows: Strategy 1, static collimation fixed at 90 degrees throughout arcs; Strategy 2, static collimator settings optimized for each arc; and Strategy 3, dynamic collimator settings optimized every 10 degrees throughout treatment arcs. Dose-volume histograms for a 0.7-cm shell of healthy peritumoral tissue were quantitatively compared. Collimator optimization schemes (Strategies 2 and 3) significantly decreased the volume of peritumoral tissue that is irradiated when compared with static collimation at 90 degrees (Strategy 1). The volume was reduced by 40.6% for Strategy 2 (95% confidence interval [CI] +/- 11) and by 47.1% for Strategy 3 (95% CI +/- 8.1) at the 95% isodose; by 28.4% for Strategy 2 (95% CI +/- 4.9) and 39.1% for Strategy 3 (95% CI +/- 6) at the 90% isodose; and by 18.2% for Strategy 2 (95% CI +/- 8.1) and 25.4% for Strategy 3 (95% CI +/- 7.1) at the 80% isodose. Serial collimator optimization throughout the treatment arcs (Strategy 3) reduced the mean volume of peritumoral tissue irradiated when compared with static collimator optimization (Strategy 2), by 16.1% (95% CI +/- 1.5) at 95% isodose, by 11.7% (95% CI +/- 1) at 90% isodose, and by 8.2% (95% CI +/- 1.2) at 80% isodose regions. In specific cases, linear or polynomial functions were formulated to optimize collimator settings dynamically throughout treatment arcs.ConclusionsDynamic collimator optimization during arc-based SRS decreases the volume of healthy peritumoral tissue treated with high doses of radiation and appears to be an effective method of improving target conformality. This study is the first step toward determination of a smoothing function algorithm to allow for true dynamic collimation during SRS.

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