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9.17 – Intensity-Modulated Radiation Therapy Planning

A. Boyer, J. Unkelbach
Published 2014 · Engineering

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Intensity-modulated radiation therapy (IMRT) is the foremost of the technical innovations in radiation oncology that have evolved in the decades bracketing the beginning of the twenty-first century. Arguably, IMRT has fundamentally changed the medical interventions for the management of cancer using ionizing radiation. This chapter surveys the foundations of the technology: computerized inverse treatment planning and computer-controlled delivery using multileaf collimators (MLC). Major issues of computerized inverse planning are reviewed, such as the formulation of IMRT as a mathematical optimization problem, the choice of objective functions, optimization algorithms, direct aperture optimization, and multicriteria planning methods. An overview is provided of the technology used for treatment delivery with medical linear accelerators equipped with MLCs. The mathematics of the step-and-shoot and dynamic leaf sequence composition are explored as well as practical dosimetry issues and examples of treatments.
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