1. Chapter 17 Intensity-Modulated Radiation Therapy
Principles and Practice of Radiation Therapy
Chapter 17 Intensity-Modulated Radiation Therapy
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Introduction
Goal of radiation therapy
The process of three-dimensional conformal therapy (3D CRT)
Intensity-modulated radiation therapy (IMRT)
Comparison and results
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Advances in Three-Dimensional Imaging
Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)
Reformatting of digital data
Postprocessing techniques
Research
Comparison studies
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Treatment Delivery Practices
3D CRT and IMRT deliver beam optimization to the tumor volume
Optimization
Homogenous radiation beam
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Adjusting Beam Shape
Multileaf collimator (MLC)
Conventional radiation therapy
Segment creates shape
Intensity-modulated field
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Adjusting Dose Delivered
Multileaf collimator intensity-modulated radiation therapy (MLC-IMRT)
Accuracy of tumor volume
Dynamic multileaf collimator (DMLC)
Dose escalation
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Image Acquisition and Simulation
The simulation process
Beam’s eye view (BMV)
Role of BMV in treatment planning
3D BEV tumor volume
Dose optimization
Role of PET in biologic imaging
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Immobilization
Custom fabrications
Role of immobilization in treatment delivery
Image-guided radiation therapy (IGRT)
Electronic portal imaging detector (EPID)
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Treatment Planning
History and role
Forward planning process, applications
Dose-volume histograms (DVH)
Inverse treatment planning processes
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

10. IMRT Treatment Delivery
Multileaf collimators
Physical modulators
MLCs, static and dynamic
Step and shoot, or segmental, MLC
Sliding window technique
Intensity-modulated arc therapy (IMAT)
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Treatment Planning Factors
Beam data
Small field calculations
Precision of MLC positioning
Dose linearity
Beam symmetry
Treatment and dosimetric verification
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Clinical Applications
Anatomic considerations
Prostate cancer
Breast cancer
Head and neck cancer
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.
Summary
Recent advances
PET/CT simulation
Low-dose/high-resolution kilovoltage x-ray imaging
4D TomoTherapy treatment technique
Summary of treatment planning
Copyright © 2010 by Mosby, Inc., an affiliate of Elsevier Inc.