{
  "abstract": "Background: Conventional VMAT optimization treats delivery time and deliverability as emergent properties of control-point-centric models that ignore finite acceleration and other dynamic limits. As linacs gain axis speed and dose rate, the plan quality-time trade-off must become explicit and steerable. Purpose: To introduce Dynamic Modulated Arc Therapy (DMAT), a time-aware, modulation-steered framework that jointly optimizes dosimetric quality, delivery time, and modulation complexity. Methods: DMAT couples direct machine emulation (axis synchronization, finite acceleration), dynamic modulation control, and clinical metrics used directly as cost functions. A user-selected modulation level (-3 to +3) governs leaf-travel allowance, total MU, aperture complexity, and control-point (CP) density. Plans are generated by progressive-resolution optimization alternating dosimetric with sequencing/deliverability updates, with non-uniform CP redistribution and complexity-reducing post-processing. DMAT was evaluated on head-and-neck, lung SBRT, and prostate SBRT cases using a hypothetical accelerated system (2.5 RPM gantry, 6.25 cm/s MLC, 3000 MU/min). Results: Increasing modulation level raised modulation surrogates (MU/Gy, aperture complexity) and delivery time, with additional CPs concentrated in arc sectors where finer angular resolution was most beneficial. The trade-off was site dependent: head-and-neck gained substantial plan quality, whereas prostate and lung SBRT gained little beyond baseline. Negative levels predictably shortened delivery time at a fixed CP budget, with quantifiable quality loss. Conclusions: DMAT co-optimizes plan quality and modulation complexity under machine-aware timing and explicit user control, making quality-time trade-offs transparent and navigable and supporting time-constrained workflows such as motion management and adaptive radiotherapy.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "Journal reference: Li T, Kuusela E, Ruokokoski E, et al. Dynamic modulated arc therapy (DMAT): A time-aware, modulation-steered optimization framework for next-generation radiotherapy delivery. J Appl Clin Med Phys.…",
  "arxiv": "2605.12891",
  "author_total": 13,
  "authors": [
    {
      "name": "Taoran Li"
    },
    {
      "name": "Esa Kuusela"
    },
    {
      "name": "Emmi Ruokokoski"
    },
    {
      "name": "Heini Hyvönen"
    },
    {
      "name": "Jerry Jaboin"
    },
    {
      "name": "Mirko Myllykoski"
    },
    {
      "name": "Jussi Nurminen"
    },
    {
      "name": "Riku Paananen"
    },
    {
      "name": "Jarkko Peltola"
    },
    {
      "name": "Marko Rusanen"
    },
    {
      "name": "Martin Sabel"
    },
    {
      "name": "Kevin Moore"
    },
    {
      "name": "Christopher Boylan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/em9br96swz1mk.bib",
  "cited_by": 0,
  "doi": "10.48550/arxiv.2605.12891",
  "fulltext_url": null,
  "id": "em9br96swz1mk",
  "issns": [],
  "landing_url": "https://arxiv.org/abs/2605.12891",
  "language": null,
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "http://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": "CC0-1.0",
  "native_subjects": [
    [
      "arxiv",
      "physics.med-ph"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://arxiv.org/pdf/2605.12891",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-02",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/em9br96swz1mk.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:16Z",
      "native_id": "2605.12891",
      "source": "arxiv",
      "url": "https://arxiv.org/abs/2605.12891"
    }
  ],
  "subjects": [
    {
      "field": "physics",
      "origin": "arxiv:physics.med-ph",
      "subfield": "biological-medical"
    }
  ],
  "title": "Dynamic Modulated Arc Therapy (DMAT): A Time Aware, Modulation Steered Optimization Framework for Next Generation Radiotherapy Delivery",
  "title_text": "Dynamic Modulated Arc Therapy (DMAT): A Time Aware, Modulation Steered Optimization Framework for Next Generation Radiotherapy Delivery",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:16Z",
  "url": "https://research.draconitic.com/paper/em9br96swz1mk",
  "venue": "arXiv",
  "versions": [
    {
      "doi": "10.1002/acm2.70764",
      "pid": null,
      "relation": "published-as",
      "title": null,
      "venue": null
    }
  ]
}