Intensity modulated radiation therapy with image guidance (IMRT/IGRT)
IMRT is a treatment advance that allows us to modulate the intensity of the radiation dose within a given radiation field. This means that the distribution of the radiation dose can be sculpted more finely around targets of interest while sparing more normal tissues. An example of this can be seen below where the axial CT image on the left is an example of a 3D-conformal plan and on the right is an example of an IMRT plan on the same patient. One can see that the IMRT plan allows the majority of the dose to be placed around the lymph nodes (which is the target) while sparing the bowel centrally.
In this other sagittal view one can also appreciate that less dose to the bladder (yellow) and rectum (brown) can be achieved with the IMRT plan on the right compared with the 3D-conformal plan on the left.
Here at UCLA we have multiple state of the art radiation treatment machines that are capable of IMRT. These include: Tomotherapy, TrueBeam, NovalisTX, and ViewRay. Because the radiation dose is more sculpted with IMRT it is critical that the patient be set up properly each day. Image guidance (IGRT) is used to verify your position and anatomy prior to your treatment to ensure that the intended radiation targets are being treated properly. Any adjustments in your setup are made and then when 100% certainty is achieved the treatment is delivered.
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