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Background  With the large-scale introduction of volumetric modulated arc therapy (VMAT), selection of optimal beam angles for coplanar static-beam IMRT has increasingly become obsolete. Due to unavailability of VMAT in current MR-linacs, the problem has re-gained importance. An application for automated IMRT treatment planning with integrated, patient-specific computer-optimization of beam angles (BAO) was used to systematically investigate computer-aided generation of beam angle class solutions (CS) for replacement of computationally expensive patient-specific BAO. Rectal cancer was used as a model case.    Materials and Methods  23 patients treated at a Unity MR-linac were included. BAO x  plans (x=7-12 beams) were generated for all patients. Analyses of BAO 12  plans resulted in CS x  class solutions. BAO x  plans, CS x  plans, and plans with equi-angular setups (EQUI x , x=9-56) were mutually compared.    Results  For x>7, plan quality for CS x  and BAO x  was highly similar, while both were superior to EQUI x . E.g. with CS 9 , bowel/bladder D mean  reduced by 22% [11%, 38%] compared to EQUI 9  (p<0.001). For equal plan quality, the number of EQUI beams had to be doubled compared to BAO and CS.    Conclusions  Computer-generated beam angle CS could replace individualized BAO without loss in plan quality, while reducing planning complexity and calculation times, and resulting in a simpler clinical workflow. CS and BAO largely outperformed equi-angular treatment. With the developed CS, time consuming beam angle re-optimization in daily adaptive MR-linac treatment could be avoided. Further systematic research on computerized development of beam angle class solutions for MR-linac treatment planning is warranted.

MR-Linac Radiotherapy – The Beam Angle Selection Problem