Intensity Modulated Radiation Therapy: A Clinical Overview (IPEM-IOP Series in Physics and Engineering in Medicine and Biology)

Intensity modulated radiation therapy (IMRT) has become standard of care for most cancer sites that are managed by radiation therapy. This book documents the evolution of this technology over 35 years to the current level of volumetric arc modulated therapy (VMAT). It covers every aspect of this radiation treatment technology, including the fundamentals of IMRT/VMAT, basic principles and advanced processes for implementation. The physics of IMRT is followed by the clinical application in major disease sites such as central nervous system, head and neck, breast, lung, prostate and cervix. It also provides updated references on each component of IMRT/VMAT. This book is written by leading experts in the field with extensive clinical experience in the practice and implementation of this technology. Key Features  Provides comprehensive coverage of IMRT for radiation therapy students, dosimetrists, physicists, medical residents and radiation professionals Includes up-to-date descriptions of current instrumentation and practises Diagrams and images are included throughout to illustrate fundamental concepts and aid understanding Provides extensive references for further reading PRELIMS.pdf Preface Author biographies Indra J Das Nicholas J Sanfilippo Antonella Fogliata Luca Cozzi Acronyms CH001.pdf Chapter 1 Introduction References CH002.pdf Chapter 2 Beam modulation 2.1 Forward planning 2.2 Paradigm shift 2.3 Simulated annealing References CH003.pdf Chapter 3 Definitions and terminology 3.1 Pixel 3.2 Voxel 3.3 Bixel (beamlet) 3.4 Intensity level 3.5 Segment 3.6 Concept of dose painting References CH004.pdf Chapter 4 IMRT devices 4.1 Intensity modulation filter/compensator 4.2 Dynamic Jaw 4.3 MLC based 4.4 Direct aperture optimization (DAO) 4.5 Systems for IMRT 4.5.1 Peacock-MIMiC 4.5.2 Tomotherapy References CH005.pdf Chapter 5 IMRT, IMAT and VMAT 5.1 IMRT 5.1.1 Step and shoot IMRT 5.1.2 Dynamic delivery IMRT 5.2 IMAT 5.3 Volumetric, modulated arc therapy, VMAT 5.4 Outlook References CH006.pdf Chapter 6 Intensity modulated planning process 6.1 IMRT planning process 6.2 Imaging 6.3 Target volume 6.4 DVH constraints 6.5 Inverse planning 6.6 MLC sequencing 6.7 Transfer and treatment sequencing 6.8 Phantom plan 6.9 IMRT PSQA 6.10 Treatment verification 6.11 Record and verification References CH007.pdf Chapter 7 Contouring 7.1 Contouring for intensity modulation inverse planning 7.2 Margins 7.3 Motion and contouring 7.4 Auto-segmentation 7.4.1 First generation of auto-segmentation methods (model-based) 7.4.2 Second generation of auto-segmentation methods 7.4.3 Third generation of auto-segmentation methods (atlas-based) 7.4.4 Fourth generation of auto-segmentation methods (deep learning) References CH008.pdf Chapter 8 Treatment planning 8.1 Beam (and arc) geometry 8.2 The collimator rotation 8.3 Non-coplanarity 8.4 Flattened and unflattened beams 8.5 Modulation degrees and delivery accuracy 8.6 The feathering: large field splitting and multi-isocentric setup 8.6.1 Overlap in the lateral direction (large volumes) 8.6.2 Overlap in the longitudinal direction (long volumes) 8.7 Artifact handling 8.8 The interplay effect 8.9 The neutron production and the whole body dose: beam quality 8.10 Conclusions on treatment planning References CH009.pdf Chapter 9 Optimization 9.1 The inverse planning concept 9.2 The goals and the cost function 9.3 The optimization objectives 9.4 The optimization algorithms 9.4.1 The deterministic algorithms 9.4.2 The stochastic algorithms 9.5 The direct aperture optimization 9.6 The biological optimization 9.6.1 The radiobiological models for TCP, NTCP, EUD 9.7 Benefit and deficiencies in biological optimization 9.8 Robust optimization References CH010.pdf Chapter 10 Dose calculation 10.1 Required accuracy in dose calculation 10.2 Dose calculation algorithms and classification 10.2.1 The empirical models 10.2.2 The semi-empirical, correction-based algorithms 10.2.3 The kernel-based algorithms: pencil beam, AAA, collapsed cone 10.2.4 The electron transport explicit algorithms: Monte Carlo, LBTE solvers 10.3 Type ‘a’, ‘b’, ‘c’ algorithm classification 10.4 Dose-to-medium or dose-to-water? 10.5 Dose calculation accuracy in various TPS implementations 10.6 Fluence to dose and MLC parameters: another source of uncertainty 10.7 The out-of-field dose 10.8 Dose calculation with metallic objects 10.9 Other elements influencing the dose calculation accuracy References CH011.pdf Chapter 11 Plan variability 11.1 Dosimetric variation: the intra- and inter-planner and planning system sources 11.2 Knowledge-based planning 11.3 Protocol-based automation 11.4 Multi-criteria optimization 11.5 MCO, a posteriori 11.6 MCO, a priori 11.7 Plan variability conclusion References CH012.pdf Chapter 12 Quality assurance and verification 12.1 Theory of comparison 12.1.1 Statistical analysis 12.1.2 Dice Similarity Coefficient (DSC) 12.1.3 Gamma index 12.2 Silico method 12.3 Measurements 12.3.1 Film dosimetry 12.3.2 Sun nuclear map check 12.3.3 IBA MatriXX 12.3.4 PTW Octavius 12.3.5 Scandidos Delta4 12.3.6 Electronic Portal Imaging Dosimetry (EPID) 12.4 Log-file approach 12.5 Artificial intelligence 12.6 Outlook References CH013.pdf Chapter 13 IMRT dose prescription and recording 13.1 Planning variability 13.2 ICRU-83 guidelines 13.3 State of compliance 13.4 Essentiality in IMRT References CH014.pdf Chapter 14 Tumors of the central nervous system 14.1 Epidemiology 14.2 Anatomic considerations 14.3 Clinical and diagnostic evaluation 14.4 Intensity modulated radiation therapy: biologic considerations 14.5 Intensity modulated radiation therapy: technical considerations 14.6 IMRT for CNS tumors: general considerations 14.7 Clinical experience of IMRT in brain tumors 14.8 Clinical experience of IMRT in spinal and paraspinal tumors 14.9 IMRT for craniospinal irradiation References CH015.pdf Chapter 15 Head and neck cancer 15.1 Epidemiology 15.2 Anatomy 15.3 Nasopharyngeal carcinoma: general considerations 15.4 IMRT for nasopharyngeal carcinoma 15.5 Oropharyngeal carcinoma: general considerations 15.6 IMRT for oropharyngeal carcinoma 15.7 Carcinoma of the oral cavity: general considerations 15.8 IMRT for oral cavity carcinoma 15.9 Cancer of the larynx and hypopharynx: general considerations References CH016.pdf Chapter 16 Lung cancer 16.1 Epidemiology 16.2 Anatomy 16.3 Lung cancer: general considerations 16.4 IMRT for lung cancer References CH017.pdf Chapter 17 Breast cancer 17.1 Epidemiology 17.2 Anatomy 17.3 Breast cancer: general considerations 17.4 IMRT for breast cancer References CH018.pdf Chapter 18 Prostate cancer 18.1 Epidemiology 18.2 Anatomy 18.3 Prostate cancer: general considerations 18.4 Prostate cancer IMRT References CH019.pdf Chapter 19 Cervical cancer 19.1 Epidemiology 19.2 Cervical cancer: general considerations 19.3 IMRT for cervical cancer References CH020.pdf Chapter 20 Summary and outlook 20.1 Plan automation, adaptive therapy and artificial intelligence: A glance into the crystal ball 20.2 Decision-making artificial intelligence (AI) guided radiotherapy References Intensity modulated radiation therapy (IMRT) has become standard of care for most cancer sites that are managed by radiation therapy. This book documents the evolution of this technology over 35 years to the current level of volumetric arc modulated therapy (VMAT). It covers every aspect of this radiation treatment technology, including the fundamentals of IMRT/VMAT, basic principles and advanced processes for implementation. The physics of IMRT is followed by the clinical application in major disease sites such as central nervous system, head and neck, breast, lung, prostate and cervix. It also provides updated references on each component of IMRT/VMAT. This book is written by leading experts in the field with extensive clinical experience in the practice and implementation of this technology. Part of IPEM-IOP Series in Physics and Engineering in Medicine and Biology.