title: Field margin reduction using intensity-modulated x-ray beams formed with a multileaf collimator.
abstract: OBJECTIVE
  In axial, coplanar treatments with multiple fields, the superior and inferior ends of a planning target volume (PTV) are at risk to get underdosed due to the overlapping penumbras of all treatment fields. We have investigated a technique using intensity modulated x-ray beams that allows the use of small margins for definition of the superior and inferior field borders while still reaching a minimum PTV-dose of 95% of the isocenter dose.
  
  
  METHODS
  The applied intensity modulated beams, generated with a multileaf collimator, include narrow (1.1-1.6 cm) boost fields to increase the dose in the superior and inferior ends of the PTV. The benefits of this technique have been assessed using 3D treatment plans for 10 prostate cancer patients. Treatment planning was performed with the Cadplan 3D planning system (Varian-Dosetek). Dose calculations for the narrow boost fields have been compared with measurements. The application of the boost fields has been tested on the MM50 Racetrack Microtron (Scanditronix Medical AB), which allows fully computer-controlled setup of all involved treatment fields.
  
  
  RESULTS
  Compared to our standard technique, the superior-inferior field length can be reduced by 1.6 cm, generally yielding smaller volumes of rectum and bladder in the high dose region. For the narrow boost fields, calculated relative dose distributions agree within 2% or 0.2 cm with measured dose distributions. For accurate monitor unit calculations, the phantom scatter table used in the Cadplan system had to be modified using measured data for square fields smaller than 4 x 4 cm2. The extra time needed at the MM50 for the setup and delivery of the boost fields is usually about 1 min.
  
  
  CONCLUSIONS
  The proposed use of intensity modulated beams yields improved conformal dose distributions for treatment of prostate cancer patients with a superior-inferior field size reduction of 1.6 cm. Treatments of other tumor sites can also benefit from the application of the boost fields.
authors.affiliation: Daniel den Hoed Cancer Center/University Hospital Rotterdam, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Dirkx
authors.forename: B J
authors.initials: BJ
authors.lastname: Heijmen
authors.forename: G A
authors.initials: GA
authors.lastname: Korevaar
authors.forename: M J
authors.initials: MJ
authors.lastname: van Os
authors.forename: J C
authors.initials: JC
authors.lastname: Stroom
authors.forename: P C
authors.initials: PC
authors.lastname: Koper
authors.forename: P C
authors.initials: PC
authors.lastname: Levendag
mesh_terms: D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012007:Rectum; D001743:Urinary Bladder