Adjoint Monte Carlo method for prostate external photon beam treatment planning: An application to 3D patient anatomy

Recently, the theoretical framework of the adjoint Monte Carlo (AMC) method has been developed using a simplified patient geometry. In this study, we extended our previous work by applying the AMC framework to a 3D anatomical model called VIP-Man constructed from the Visible Human images. First, the adjoint fluxes for the prostate (PTV) and rectum and bladder (organs at risk (OARs)) were calculated on a spherical surface of 1 m radius, centred at the centre of gravity of PTV. An importance ratio, defined as the PTV dose divided by the weighted OAR doses, was calculated for each of the available beamlets to select the beam angles. Finally, the detailed doses in PTV and OAR were calculated using a forward Monte Carlo simulation to include the electron transport. The dose information was then used to generate dose volume histograms (DVHs). The Pinnacle treatment planning system was also used to generate DVHs for the 3D plans with beam angles obtained from the AMC (3D-AMC) and a standard six-field conformal radiation therapy plan (3D-CRT). Results show that the DVHs for prostate from 3D-AMC and the standard 3D-CRT are very similar, showing that both methods can deliver prescribed dose to the PTV. A substantial improvement in the DVHs for bladder and rectum was found for the 3D-AMC method in comparison to those obtained from 3D-CRT. However, the 3D-AMC plan is less conformal than the 3D-CRT plan because only bladder, rectum and PTV are considered for calculating the importance ratios. Nevertheless, this study clearly demonstrated the feasibility of the AMC in selecting the beam directions as a part of a treatment planning based on the anatomical information in a 3D and realistic patient anatomy.