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Book and Media Reviews
IMRT, IGRT, SBRT Advances in the treatment planning and delivery of radiotherapy
Department of Radiation Medicine, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
J Gastrointest Oncol 2011; 2: 265. DOI: 10.3978/j.issn.2078-6891.2011.043
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Improvements in computing power and imaging
technologies have fueled the development of sophisticated
radiation treatment planning and delivery. This book is a
comprehensive review of the new technologies, and their
applications in clinical practice.
The book is divided into four sections. The first section
offers a detailed description of the new technologies such as
intensity-modulated arc therapy, 4D imaging and delivery
and different linear accelerator platforms that incorporate
these new technologies. The second describes how the
technologies are applied in the clinic, in a site-specific
manner. The third section is dedicated specifically to SBRT,
a treatment that is made possible through the marriage of
IMRT and IGRT. The last section addresses the unique
capabilities and applications of proton therapy.
What sets this book apart is that it is extremely practical.
Each clinical chapter guides the reader through how to
treat a patient utilizing the new technologies. It includes the
key steps such as simulation, target delineation, treatment
planning, plan evaluation, and treatment set-up and
delivery. Each chapter also includes a summary of reported
clinical outcomes. The book includes full-color illustrations
and case examples that are easy to follow. Complementing
the text are on-line supplementary materials, including
videos that help to illustrate 4D technology and tumor motion management.
The text also includes a chapter on the economic impact
of these new technologies. In 2009, health care spending
in the United States was $2.47 trillion, accounting for
17.3% of GDP, which is significantly higher than any other
developed nation. The authors pointed out that IMRT
(CPT code 77418) increased from 38th to 18th in total cost to
Medicare from 2004 to 2007 and that radiation oncologists
represent only 0.3% of Medicare service providers while
accounting for 3% of total costs. This discussion serves as an
important reminder to us all that the incremental benefit of
these new technologies must be carefully weighed against
cost. Prospective clinical trials with well-defined and
meaningful clinical endpoints are needed to fully establish
the value of technical improvements. In addition, economic
considerations also call for development of cost-saving
technologies, such as intensity modulated arc therapy, that
reduces treatment time and improves clinical throughput.
Overall, this book is a comprehensive, but not overwhelming
resource for radiat ion oncolog ist s, phy sic ist s and
technologists. The amount of information is well distributed
among the text, figures and tables. It is an excellent guide to
understanding application of new technologies in radiation
oncology.
Cite this article as: Kubicky C. IMRT, IGRT, SBRT Advances in the treatment planning and delivery of radiotherapy. J Gastrointest Oncol. 2011;2(4):265. DOI: 10.3978/j.issn.2078-6891.2011.043
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