The static leaf sequencing (SLS) problem arises in radiation therapy for cancer treatments, aiming to accomplish the delivery of a radiation prescription to a target tumor in the minimum amount of delivery time. Geometrically, the SLS problem can be formulated as a 3-D partition problem for which the 2-D problem of partitioning a polygonal domain (possibly with holes) into a minimum set of monotone polygons is a special case. In this paper, we present new geometric algorithms for a basic case of the 3-D SLS problem (which is also of clinical value) and for the general 3-D SLS problem. Our basic 3-D SLS algorithm, based on new geometric observations, produces guaranteed optimal quality solutions using O(1) Steiner points in polynomial time; the previously best known basic 3-D SLS algorithm gives optimal outputs only for the case without considering any Steiner points, and its time bound involves a multiplicative factor of a factorial function of the input. Our general 3-D SLS algorithm is based on our basic 3-D SLS algorithm and a polynomial time algorithm for partitioning a polygonal domain (possibly with holes) into a minimum set of x-monotone polygons, and has a fast running time. Experiments of our SLS algorithms and software in clinical settings have shown substantial improvements over the current most popular commercial treatment planning system and the most well-known SLS algorithm in medical literature. The radiotherapy plans produced by our software not only take significantly shorter delivery times, but also have a much better treatment quality. This proves the feasibility of our software and has led to its clinical applications at the Department of Radiation Oncology at the University of Maryland Medical Center. Some of our techniques and geometric procedures (e.g., for partitioning a polygonal domain into a minimum set of x-monotone polygons) are interesting in their own right.
Inverse planning in the age of digital LINACs: station parameter optimized radiation therapy (SPORT)