Accommodating practical constraints for intensity-modulated radiation therapy by means of compensators

Radiotherapy (RT) is an important weapon in the arsenal of treatment modalities to fight cancer. It has been applied for curative and palliative management of cancer for more than a century. Intensity-modulated radiation therapy (IMRT) is a specialised RT treatment technique, which is on the verge of being routinely implemented in clinical environments within the National Health Service. In contrast to the uniform beams used for traditional RT, the aim of IMRT is to modulate the intensity of a set of high-energy photon beams in such a way that the dose can be tailored to the shape of the designated region to be treated, whilst at the same time sparing surrounding healthy tissues and critical organs. Because of normal tissue avoidance and the ability to escalate dose, acute radiation toxicity in IMRT is reduced. This thesis deals with the practical implementation of IMRT generated by means of patient specific metal compensators. Intensity modulation is achieved by placing a profiled compensator in the beam path in order to attenuate the beam differentially. A comprehensive comparison between several compensator-machining techniques, with respect to their suitability for production within a hospital workshop, is presented. The limitations associated with the selected compensator manufacturing techniques are identified and implemented as constraints in an existing inverse treatment-planning algorithm. In order to obtain the profile of a compensator, which produces a desired intensity distribution, inverse modelling of the radiation attenuation within the compensator is required. Two novel and independent approaches, based on deconvolution and system identification, respectively, are proposed to accomplish this. To compare the approach with the 'rival' state of the art beam modulation technique, theoretical and experimental examination of the modulated fields generated by manufactured compensators and multileaf collimators is presented. This comparison focused on the achievable resolution of the intensity modulated beams in lateral and longitudinal directions. To take into account the characteristics of a clinical environment, a comprehensive study has been carried out to investigate the suitability of the most common commercially available treatment couch systems for their suitability for IMRT treatments. In this context, an original rule based advisory system has been developed to alert the operator of any potential collision of the beam with the moveable supporting structures of the treatment couch. The system is capable of finding alternative positions for the supporting frames and, if necessary, can suggest alternative beam directions. Finally, a head and neck phantom has been designed for gel dosimetry to assess IMRT treatment delivery techniques. The phantom is based on a simplistic but realistic design and contains the main anatomical features. (author)