Dynamic Modulated Arc Therapy (DMAT): A Time Aware, Modulation Steered Optimization Framework for Next Generation Radiotherapy Delivery
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.
Versions
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BibTeX
@misc{li2026dynamic,
title = {{Dynamic Modulated Arc Therapy (DMAT): A Time Aware, Modulation Steered Optimization Framework for Next Generation Radiotherapy Delivery}},
author = {Taoran Li and Esa Kuusela and Emmi Ruokokoski and Heini Hyvönen and Jerry Jaboin and Mirko Myllykoski and Jussi Nurminen and Riku Paananen and Jarkko Peltola and Marko Rusanen and Martin Sabel and Kevin Moore and Christopher Boylan},
howpublished = {arXiv},
year = {2026},
month = sep,
doi = {10.48550/arxiv.2605.12891},
eprint = {2605.12891},
archivePrefix = {arXiv},
url = {https://arxiv.org/abs/2605.12891},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - UNPB
TI - Dynamic Modulated Arc Therapy (DMAT): A Time Aware, Modulation Steered Optimization Framework for Next Generation Radiotherapy Delivery
AU - Taoran Li
AU - Esa Kuusela
AU - Emmi Ruokokoski
AU - Heini Hyvönen
AU - Jerry Jaboin
AU - Mirko Myllykoski
AU - Jussi Nurminen
AU - Riku Paananen
AU - Jarkko Peltola
AU - Marko Rusanen
AU - Martin Sabel
AU - Kevin Moore
AU - Christopher Boylan
PY - 2026
DA - 2026/09/02
PB - arXiv
DO - 10.48550/arxiv.2605.12891
UR - https://arxiv.org/abs/2605.12891
AB - 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.
ER -