The evolution of radiation therapy treatment techniques coupled with improved targeting by 3D onboardimaging and real-time adaptive IMRT replanning makes possible the delivery of more conformal dosedistributions to targets with substantially reduced margins in comparison with historical radiation therapypractice. A key component of image guided adaptive radiation therapy (IGART) is planning and tracking ofdose distributions on multiple deforming presentations of the patient anatomy. Performing such complexdose calculations in the context of rapid IMRT optimization presents a number of scientific challenges. Firstdose computation on deforming anatomies may add dose uncertainties, which results in decreasedtreatment effectiveness. Secondly, optimal IGART application will require that accurate dose calculations beperformed much more rapidly than is possible with present algorithms. Finally, even when onboard 3Dimaging-based setup adjustments are applied, residual systematic and random uncertainties will remain andneed to be considered during planning. The goals of this Project are: (1) To develop methods to evaluate and minimize dose errors and doseuncertainty introduced by adding dose distributions acquired at different presentations of the patient'sanatomy so as to accurately quantify and ensure effective dose delivery for IGART. (2) To develop andvalidate efficient, accurate dose algorithms for use with deformed image sets so as to enable rapid plan re-optimization and plan re-evaluation for IGART. (3) To develop and compare methods to account for residualdosimetric and targeting uncertainties and errors during plan IMRT optimization for IGART treatmentdelivery. The long term objectives of this Program are to develop and implement optimal IGART methods, to usethese methods to enable dose-per-fraction escalation, and to improve patient outcomes through delivery ofhighly conformal dose distributions with minimal dose uncertainty. This project will benefit public health by developing techniques that will improve quantification of radiationtherapy doses delivered to patients throughout their course of radiation therapy as their anatomy changesdue to responses to the treatment or other processes. The project will develop techniques to reduce theamount of normal tissues irradiated, thereby enabling a reduction in complication rates and improvement incontrol rates for patients treated with radiationtherapy.
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