IMRT Basics: R. Alfredo C. Siochi, Ph.D. Juan Carlos Celi, PH.D
IMRT Basics: R. Alfredo C. Siochi, Ph.D. Juan Carlos Celi, PH.D
IMRT Basics: R. Alfredo C. Siochi, Ph.D. Juan Carlos Celi, PH.D
Conventional Radiotherapy Basic 2 to 4 fields blocks and wedges Virtual Wedges MLC shaped fields 4 fields ~15 min. ICRU-50 concepts difficult to achieve Faster ICRU-50
Advanced
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Figure 2 - Conventional Radiotherapy
Conformal Radiotherapy
Not a new concept: 1950-60 Proimos and Takahashi. Main idea: high doses to the tumor; minimum doses to the normal tissues. Purpose: to conform selected isodoses around the tumor and avoid critical structures.
Conformal Radiotherapy
Several fields (6 - 10) Comparative analysis - DVH, max. and min. doses - Average doses - Biological effect doses MLC shapes, wedges PRIMEVIEW: Automatic Field Sequencing automatic transition verification control
Basic
Advanced
Conventional Radiotherapy
Based on the combination of several fields at different gantry angles, conventional treatments are still in use for several clinical applications. In order to achieve conformality, blocks and wedges are applied to the original fields. ICRU criteria are in many situations difficult to comply. To optimize the treatment process, MLC shaped fields were introduced and later with automatic wedges (virtual wedges).
IMRT Basics
68 Gy 60 Gy 50 Gy 30 Gy
Figure 4 - Conformal vs. Conventional: better isodose conformity, less dose to the normal tissues.
Figure 5 - IMRT: sculpt the doses (isodoses) to the tumor, avoiding the surrounding healthy tissues.
Why IMRT?
To spare organs-at-risk For irregular shaped targets To treat multiple targets simultaneously To enable dose escalation To treat regions with prior radiation
In the interior of the shaped field, the doses are homogeneous. Qualitatively conforms to the shape of the target and minimizes dose to critical structures through selection of beam directions and beam shapes.
In the interior of the shaped field, the doses are heterogeneous, for dose modulation. Produces dose distributions that conform tightly to the 3D shape of the target by varying the beam intensity across the shaped fields
Figure 9 - Conformal avoidance and dose escalation. From: T. Bortfeld, Optimized Planning Using Physical Objectives and Constraints, Semin. Radiat. Oncol. 9: 20-34, 1999.
IMRT: modalities
By planning: Forward planned IMRT Aperture based IMRT Inverse planned IMRT Monte Carlo based IMRT By delivery systems: Multileaf Collimators MLC Micro-, Mini-, Virtual-Micro MLC Tomotherapy devices By treatment techniques: Segmented sequential (step and shoot) Cinematic sequential (Cinematic IMRT) Dynamic sequential (sliding window) Intensity Modulated Arc Therapy (IMAT) Tomotherapy
General Definitions
Figure 8 - Discrete Modulation of Fluences with an MLC
Why do it?
IMRT creates superior dose volume histograms compared to conventional RT. At the DVH, the separation between target dose and Organ at Risk (OAR) doses is greater. In theory, that allows for dose escalation to the target, if necessary. The concept of conformal avoidance takes place.
Static IMRT Nothing moves when the beam is on Fields with segmentation Also known as step and shoot method Dynamic IMRT Leaves (modifiers) move when the beam is on Fields with segmentation plus contribution of the doses between segments Sliding window Arc-therapy with IMRT
IMRT Basics