Effects of minimum monitor unit per dynamic control point on intensity‐modulated radiotherapy planning for nasopharyngeal carcinoma: A retrospective study

The present study aimed to improve the dose distribution of radiotherapy planning for nasopharyngeal carcinoma (NPC) by comparing the effects of various minimum monitor units (MUs) per dynamic control point (MMCP) values on the quality and execution efficiency of dynamic intensity-modulated radiotherapy (IMRT) planning. Thirty-four clinically implemented dynamic IMRT plans for patients with NPC were retrospectively selected. In total, 170 plans were obtained by modifying only the MMCP values (set as 1, 3, 5, 7, and 9) in the treatment planning system's (TPS) optimization parameters. These plans were divided into 5 groups. Analyzing the effects of MMCP on the target and organ dose at risk (OAR), also the execution efficiency of the treatment plan in each group and using a quality score system, we conducted an objective quantitative study of the dose distribution and execution efficiency. The target dose evaluation indicators (target coverage (TC), homogeneity index (HI), and conformity index (CI)) of all IMRT plans showed a trend of variation with an increase in MMCP values, and the difference was statistically significant when MMCP values were 5, 7, 9, and 1 (p < 0.05). With an increase in MMCP, the dose to OAR slightly increased, but the difference was not statistically significant (p > 0.05). With an increase in MMCP, the average number of MUs per segment significantly increased (p < 0.01). The groups based on MMCP values of 1, 3, 5, 7, and 9 received quality score system of 1.188, 1.180, 1.171, 0.987, and 1.184, respectively, with the MMCP7 group achieving the lowest score, indicating that this plan had the highest overall quality. The MMCP value for dynamic IMRT planning in the Monaco TPS for patients with NPC should be set to 7 to achieve fewer segments, the best execution efficiency without significantly deteriorating the target and OAR dose.