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Purpose:  To develop a novel aperture‐based algorithm for volumetric modulated arc therapy (VMAT) treatment plan optimization with high quality and high efficiency.    Methods:  The VMAT optimization problem is formulated as a large‐scale convex programming problem solved by a column generation approach. The authors consider a cost function consisting two terms, the first enforcing a desired dose distribution and the second guaranteeing a smooth dose rate variation between successive gantry angles. A gantry rotation is discretized into 180 beam angles and for each beam angle, only one MLC aperture is allowed. The apertures are generated one by one in a sequential way. At each iteration of the column generation method, a deliverable MLC aperture is generated for one of the unoccupied beam angles by solving a subproblem with the consideration of MLC mechanic constraints. A subsequent master problem is then solved to determine the dose rate at all currently generated apertures by minimizing the cost function. When all 180 beam angles are occupied, the optimization completes, yielding a set of deliverable apertures and associated dose rates that produce a high quality plan.    Results:  The algorithm was preliminarily tested on five prostate and five head‐and‐neck clinical cases, each with one full gantry rotation without any couch/collimator rotations. High quality VMAT plans have been generated for all ten cases with extremely high efficiency. It takes only 5–8 min on CPU ( MATLAB  code on an Intel Xeon 2.27 GHz CPU) and 18–31 s on GPU ( CUDA  code on an NVIDIA Tesla C1060 GPU card) to generate such plans.    Conclusions:  The authors have developed an aperture‐based VMAT optimization algorithm which can generate clinically deliverable high quality treatment plans at very high efficiency.

Ultrafast treatment plan optimization for volumetric modulated arc therapy (VMAT)