A multileaf collimator (MLC) is a Collimator or beam-limiting device that is made of individual "leaves" of a high atomic numbered material, usually tungsten, that can move independently in and out of the path of a radiotherapy beam in order to shape it and vary its intensity.
MLCs are used in external beam radiotherapy to provide conformal shaping of beams. Specifically, conformal radiotherapy and Intensity Modulated Radiation Therapy (IMRT) can be delivered using MLCs.
The MLC has improved rapidly since its inception and the first use of leaves to shape structures in 1965 [1] to modern day operation and use. MLCs are now widely used and have become an integral part of any radiotherapy department. MLCs were primarily used for conformal radiotherapy, and have allowed the cost-effective implementation of conformal treatment with significant time saving, [2] and also have been adapted for use for IMRT treatments. For conformal radiotherapy the MLC allows conformal shaping of the beam to match the borders of the target tumour. For intensity modulated treatments the leaves of a MLC can be moved across the field to create IMRT distributions (MLCs really provide a fluence modulation rather than intensity modulation).
The MLC is an important tool for radiation therapy dose delivery. It was originally used as a surrogate for alloy block field shaping and is now widely used for IMRT. As with any tool used in radiotherapy the MLC must undergo commissioning and quality assurance. Additional commissioning measurements are completed to model a MLC for treatment planning. Various MLCs are provided by different vendors and they all have unique design features as determined by specifications of design, [3] and these differences are quite significant.
Radiation therapy or radiotherapy is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle accelerator. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body, and have not spread to other parts. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor. Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology. A physician who practices in this subspecialty is a radiation oncologist.
External beam radiation therapy (EBRT) is a form of radiotherapy that utilizes a high-energy collimated beam of ionizing radiation, from a source outside the body, to target and kill cancer cells. A radiotherapy beam is composed of particles which travel in a consistent direction; each radiotherapy beam consists of one type of particle intended for use in treatment, though most beams contain some contamination by other particle types.
A radiation oncologist is a specialist physician who uses ionizing radiation in the treatment of cancer. Radiation oncology is one of the three primary specialties, the other two being surgical and medical oncology, involved in the treatment of cancer. Radiation can be given as a curative modality, either alone or in combination with surgery and/or chemotherapy. It may also be used palliatively, to relieve symptoms in patients with incurable cancers. A radiation oncologist may also use radiation to treat some benign diseases, including benign tumors. In some countries, radiotherapy and chemotherapy are controlled by a single oncologist who is a "clinical oncologist". Radiation oncologists work closely with other physicians such as surgical oncologists, interventional radiologists, internal medicine subspecialists, and medical oncologists, as well as medical physicists and technicians as part of the multi-disciplinary cancer team. Radiation oncologists undergo four years of oncology-specific training whereas oncologists who deliver chemotherapy have two years of additional training in cancer care during fellowship after internal medicine residency in the United States.
Brachytherapy is a form of radiation therapy where a sealed radiation source is placed inside or next to the area requiring treatment. Brachy is Greek for short. Brachytherapy is commonly used as an effective treatment for cervical, prostate, breast, esophageal and skin cancer and can also be used to treat tumours in many other body sites. Treatment results have demonstrated that the cancer-cure rates of brachytherapy are either comparable to surgery and external beam radiotherapy (EBRT) or are improved when used in combination with these techniques. Brachytherapy can be used alone or in combination with other therapies such as surgery, EBRT and chemotherapy.
In medicine, proton therapy, or proton radiotherapy, is a type of particle therapy that uses a beam of protons to irradiate diseased tissue, most often to treat cancer. The chief advantage of proton therapy over other types of external beam radiotherapy is that the dose of protons is deposited over a narrow range of depth; hence in minimal entry, exit, or scattered radiation dose to healthy nearby tissues.
A collimator is a device which narrows a beam of particles or waves. To narrow can mean either to cause the directions of motion to become more aligned in a specific direction, or to cause the spatial cross section of the beam to become smaller.
Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy, it is usually used to treat cancer. Radiosurgery was originally defined by the Swedish neurosurgeon Lars Leksell as "a single high dose fraction of radiation, stereotactically directed to an intracranial region of interest".
Varian Medical Systems is an American radiation oncology treatments and software maker based in Palo Alto, California. Their medical devices include linear accelerators (LINACs) and software for treating cancer and other medical conditions with radiotherapy, radiosurgery, proton therapy, and brachytherapy. The company supplies software for managing cancer clinics, radiotherapy centers, and medical oncology practices. Varian Medical Systems employs more than 7,100 people at manufacturing sites in North America, Europe, and China and approximately 70 sites globally.
Fast neutron therapy utilizes high energy neutrons typically between 50 and 70 MeV to treat cancer. Most fast neutron therapy beams are produced by reactors, cyclotrons (d+Be) and linear accelerators. Neutron therapy is currently available in Germany, Russia, South Africa and the United States. In the United States, one treatment center is operational, in Seattle, Washington. The Seattle center uses a cyclotron which produces a proton beam impinging upon a beryllium target.
In radiotherapy, radiation treatment planning (RTP) is the process in which a team consisting of radiation oncologists, radiation therapist, medical physicists and medical dosimetrists plan the appropriate external beam radiotherapy or internal brachytherapy treatment technique for a patient with cancer.
Tomotherapy is a type of radiation therapy treatment machine. In tomotherapy a thin radiation beam is modulated as it rotates around the patient, while they are moved through the bore of the machine. The name comes from the use of a strip-shaped beam, so that only one “slice” of the target is exposed at any one time by the radiation. The external appearance of the system and movement of the radiation source and patient can be considered analogous to a CT scanner, which uses lower doses of radiation for imaging. Like a conventional machine used for X-ray external beam radiotherapy, a linear accelerator generates the radiation beam, but the external appearance of the machine, the patient positioning, and treatment delivery is different. Conventional linacs do not work on a slice-by-slice basis but typically have a large area beam which can also be resized and modulated.
Image-guided radiation therapy is the process of frequent imaging, during a course of radiation treatment, used to direct the treatment, position the patient, and compare to the pre-therapy imaging from the treatment plan. Immediately prior to, or during, a treatment fraction, the patient is localized in the treatment room in the same position as planned from the reference imaging dataset. An example of IGRT would include comparison of a cone beam computed tomography (CBCT) dataset, acquired on the treatment machine, with the computed tomography (CT) dataset from planning. IGRT would also include matching planar kilovoltage (kV) radiographs or megavoltage (MV) images with digital reconstructed radiographs (DRRs) from the planning CT.
The CyberKnife system is a radiation therapy device manufactured by Accuray. The system is used to deliver radiosurgery for the treatment of benign tumors, malignant tumors and other medical conditions.
A dose-volume histogram (DVH) is a histogram relating radiation dose to tissue volume in radiation therapy planning. DVHs are most commonly used as a plan evaluation tool and to compare doses from different plans or to structures. DVHs were introduced by Michael Goitein and Verhey in 1979. DVH summarizes 3D dose distributions in a graphical 2D format. In modern radiation therapy, 3D dose distributions are typically created in a computerized treatment planning system (TPS) based on a 3D reconstruction of a CT scan. The "volume" referred to in DVH analysis is a target of radiation treatment, a healthy organ nearby a target, or an arbitrary structure.
Wolfgang Axel Tomé is a physicist working in medicine as a researcher, inventor, and educator. He is noted for his contributions to the use of photogrammetry in high precision radiation therapy; his work on risk adaptive radiation therapy which is based on the risk level for recurrence in tumor sub-volumes using biological objective functions; and the development of hippocampal avoidant cranial radiation therapy techniques to alleviate hippocampal-dependent neurocognitive impairment following cranial irradiation.
Christopher M. Nutting is a British Professor of Clinical Oncology and medical consultant, specializing in head and neck cancers, who has helped develop Intensity-Modulated Radiotherapy (IMRT), an advanced form of Radiation therapy.
Gel dosimeters, also called Fricke gel dosimeters, are manufactured from radiation sensitive chemicals that, upon irradiation with ionising radiation, undergo a fundamental change in their properties as a function of the absorbed radiation dose.
Radhe Mohan is a medical physicist who significantly advanced radiation treatment safety for oncology patients. He is a recipient of the ASTRO Gold Medal for outstanding contributions in the field of radiation oncology.
Dr. Daniel Przybysz is a Brazilian Radiation-Oncologist. His practice is mainly focused on lung cancer treatment and high technology approaches toward better patient care
FLASH radiotherapy is an emerging form of radiotherapy which delivers a high dose of radiation to the patient in an ultra-short time frame which produces a tumour killing effect comparable to conventional radiotherapy but with less damage to surrounding healthy tissue. The treatment is in the early stages of development and is not yet widely available as a form of cancer therapy.