Intensity modulated radiation therapy--the shape of things to come?

Over the past century, the field of radiation oncology has seen tremendous technological advances. Some of these advances relate to biomedical accomplishments, while many are directly related to those achieved in computing and information technology. For example, developments in radiation treatment planning systems are intimately connected to progress in all of computing, and have culminated in the ability of radiation oncologists to accurately plan even the most complex therapy. Treatment machines, themselves tooled with embedded computer chips and processors, have evolved from rigid monstrosities to highly flexible, compact, machines capable of moving with robotic-like precision. The addition of multi-leaf collimators to these treatment machines has added yet another dimension to the picture. The ability to coordinate the fine motor movements of these collimators along with the coarser movements of the machine itself has required a level of control not possible manually. Computers again have provided a solution, and the result was not just a new means of directing the radiation beam, but a revolution in how radiation itself was delivered Intensity Modulated Radiation Therapy. Now, Intensity Modulated Radiation Therapy (IMRT) is practiced in hundreds of radiation oncology departments worldwide. The administration process, which challenges the most sophisticated computer planning and treatment control systems, requires not just proficient technical support, but also a dedicated administrative infrastructure. The payoff, however, promises to be big. Preliminary clinical outcome reports suggest that significant reductions in toxicity will be achievable, making increased control rates more likely. In addition, favorable CMS reimbursement changes make it probable that the technology will spread rapidly throughout the radiation oncology community. Studies are ongoing to help identify the most appropriate use of the therapy. Ultimately, IMRT is likely to become a readily available treatment for use in select cases.