American College of Radiology (ACR) and American Society for Radiation Oncology (ASTRO) Practice Guideline for Intensity-modulated Radiation Therapy (IMRT)

Abstract

Intensity-modulated radiation therapy (IMRT) is a complex technique for the delivery of radiation therapy preferentially to target structures while minimizing doses to adjacent normal critical structures. It is widely utilized in the treatment of a variety of clinical indications in radiation oncology, including tumors of the central nervous system, head and neck, breast, prostate, gastrointestinal tract, and gynecologic organs, as well as in situations where previous radiation therapy has been delivered, and has allowed for significant therapeutic advances in many clinical areas. IMRT treatment planning and delivery is a complex process. Safe and reliable delivery of IMRT requires appropriate process design and adherence to quality assurance (QA) standards. A collaborative effort of the American College of Radiology and American Society for Therapeutic Radiation Oncology has produced a practice guideline for IMRT. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist, dosimetrist, and radiation therapist. Factors with respect to the QA of the treatment planning system, treatment-planning process, and treatment-delivery process are discussed, as are issues related to the utilization of volumetric modulated arc therapy. Patient-specific QA procedures are presented. Successful IMRT programs involve integration of many processes: patient selection, patient positioning/immobilization, target definition, treatment plan development, and accurate treatment delivery. Appropriate QA procedures, including patient-specific QA procedures, are essential to ensure quality in an IMRT program and to assure patient safety.

Combination of Linear Accelerator–Based Intensity-Modulated Total Marrow Irradiation and Myeloablative Fludarabine/Busulfan: A Phase I Study

“…b b m t . o r g radiation therapy (IMRT) is an alternate method of radiation delivery commonly used in the treatment of solid tumors that allows the prescribed dose to be conformed to the target while sparing adjacent normal organs [18]. An IMRT approach to irradiate bone marrow selectively while sparing other organs (total marrow irradiation, TMI) has been previously described in clinical trials using helical tomotherapy [19][20][21][22][23][24][25], whereas we have previously reported preclinical studies on the feasibility of performing linear acceleratorebased intensity-modulated TMI [26][27][28][29].…”

3D VMAT Verification Based on Monte Carlo Log File Simulation with Experimental Feedback from Film Dosimetry

“…Nevertheless, the completely dynamic implementation involves an added complexity to the planning, since additionally to the dynamic multi-leaf collimator (MLC) movement, the dose rate and gantry motion have to be synchronized during irradiation [2]. New uncertainties about this dynamic nature of the VMAT delivery increase the complexity of the associated quality assurance (QA) [3–5]. Therefore, new QA systems are continuously becoming available, while also there exist no clear guidelines and criteria for the accuracy required.…”

Cancer Survivorship

“…Recently, the American Society for Radiation Oncology and the American College of Radiology have jointly published guidelines for IMRT and high dose rate brachytherapy (Erickson et al 2011 ;Hartford et al 2012 ).…”