Limitations of a simple technique for movement compensation via movement-modified fluence profiles

The delivery of intensity-modulated radiation therapy (IMRT) through the dynamic multileaf collimator (dMLC) technique is well known and recently it has been shown how this can be modified to deliver fluence to a body which is moving in a regular and totally predictable manner. This involves making the leaves 'breath' in tandem with the body motion. This note presents an entirely alternative suggestion in which the leaves do not 'breath' at all but the fluence profile to be mapped to the unbreathing leaf motions is modified so that, when sampled by the specified motion, the actual fluence delivered is close to the desired fluence. Limitations of the concept are discussed.