[Use experience and problems in the optimization of intensity modulated radiation therapy (IMRT)--Focus on head &...

We present the main points of the optimization in IMRT. The skin surface of the planned target volume was reduced by a few millimeters, in view of the limitations of a calculation grid in accurately estimating the influence of build-up or contamination of electrons. Air cavities such as nasal or oral cavities were, in general, filled with water equivalent density in the dose calculation. Planned target volume was contracted by 5 mm when PTV of a higher prescribed dose was delineated adjacent to it. The 5 mm width of ring-shaped ROI was set at 5 mm outside of the entire PTV to eliminate hot spots. Physical quality assurance is extremely important to eradicate unexpected dose inhomogeneity, and meticulous efforts are required.