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The main approach to smooth Pareto surface navigation for radiation therapymulti-criteria treatment planning involves taking real-time averages ofpre-computed treatment plans. In fluence-based treatment planning, fluence mapsthemselves can be averaged, which leads to the dose distributions beingaveraged due to the linear relationship between fluence and dose. This worksfor fluence-based photon plans and proton spot scanning plans. In thistechnical note, we show that two or more sliding window volumetric modulatedarc therapy (VMAT) plans can be combined by averaging leaf positions in acertain way, and we demonstrate that the resulting dose distribution for theaveraged plan is approximately the average of the dose distributions of theoriginal plans. This leads to the ability to do Pareto surface navigation, i.e.interactive multi-criteria exploration of VMAT plan dosimetric tradeoffs.

Averaging VMAT treatment plans for multi-criteria navigation