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Intensity-modulated radiation therapy (IMRT): a clinical reality for cancer treatment, "any fool can understand this"

The 2004 Silvanus Thompson Memorial Lecture

Joint Department of Physics, Institute of Cancer Research (University of London) and Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK

View larger version (92K): [in a new window]   Figure 1. Silvanus Thompson and apparatus for "mesmerising" (stimulating retinal light by magnetism).

View larger version (78K): [in a new window]   Figure 2. Silvanus Thompson's famous book on calculus.

View larger version (69K): [in a new window]   Figure 3. Shows a "classic" application for IMRT, to conform the high dose to the non-uniform shape of the prostate simultaneously sparing dose to normal rectum and bladder.

View larger version (72K): [in a new window]   Figure 4. 3D data deduced from X-ray CT images. OAR, organ at risk.

View larger version (54K): [in a new window]   Figure 5. Just two (of several) modulated beams create an invaginated contour for the high-dose volume.

View larger version (101K): [in a new window]   Figure 6. Components of an "Ellis compensator".

View larger version (19K): [in a new window]   Figure 7. Essence of the multiple-static multileaf collimator (MSF-MLC) technique. Thomas Bortfeld first described the step-and-shoot MLC technique in 1993. (a) Approximate profile by steps. (b) Leaf sweep realisation.

View larger version (52K): [in a new window]   Figure 8. Pre-computer-3D dose display by Art(ist) Boyer. In 1993 Thomas Bortfeld and Art Boyer made the first IMRT step-and-shoot delivery in Houston using a Varian machine and taking about 3 hours to reset fields by hand. They drew this graphic 3D display of dose.

View larger version (28K): [in a new window]   Figure 9. Tomotherapy.

View larger version (80K): [in a new window]   Figure 10. Quality assurance of the pelvic IMRT via a Bortfeld-Boyer experiment. Upper right shows the measured dose distribution in a slice and lower right shows the calculated distribution.

View larger version (13K): [in a new window]   Figure 11. The motion of internal markers is detected by X-rays; motion of external markers is detected by infrared. Motions are correlated every 10 s. Monitor of external markers by infrared then translates to movement of internal tumour markers in almost real-time and this is fed back to the robot [40].

View larger version (57K): [in a new window]   Figure 12. The press has been interested following David Dearnaley's initiative.