By John M. Mathis
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Additional info for Image-Guided IMRT
Example text
By using information on patient breathing, it has now become possible to obtain respiratory correlated CT scans [7, 8]. Respiration correlated (4D) CT is the technique of choice for accurate determination of lung tumor motion for treatment planning. An alternative is to use slow scanning [9], where a more representative CT scan is acquired, compared to a free breathing CT, at the cost of image resolution. MV cone-beam CT (CB CT) has been proposed for image guidance application on conventional accelerators (with moderate success).
Subsequently, a margin can be computed using these standard deviations. • Systematic errors require three to four times more margin than random errors. To reduce the required margin it is therefore most efficient to focus on reducing the systematic errors first, by using clear delineation protocols, multi-modality imaging and setup correction protocols. 6 Future Developments For the specific case where the requirement is a minimum CTV dose of 95% to 90% of the patients a simple Because of the importance geometrical uncertainties play in the quest for smaller margins, imaging will become more and more important for IMRT.
For instance, if one draws along a slice of the CT, MRI slices will be shown resampled or vice-versa. 5 Geometric Uncertainties and Margins IMRT aims at maximizing tumor control while minimizing damage to the surrounding tissues. To increase the therapeutic range, smaller and smaller margins are being used between the clinical target volume (CTV), and 23 24 I. Foundations the planning target volume (PTV) [41], and thus a much higher conformality is attained. Since high precision is essential, each step in the IMRT procedure must be image guided and roughly based on the three following steps: 1.
