Intensity Modulated Treatment Delivery, Single or Multiple Fields/Arcs (G6015)

Name of the Procedure:

Intensity Modulated Radiation Therapy (IMRT)

Summary

Intensity Modulated Radiation Therapy (IMRT) is an advanced form of radiation therapy used to treat cancer and other conditions. It delivers precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation beams are modulated, meaning their intensity can be varied, and they can be delivered from multiple angles.

Purpose

IMRT is used to maximize the radiation dose to the tumor while minimizing exposure to the surrounding healthy tissue. It is often employed in treating cancers that are located near sensitive structures, such as in the head and neck, prostate, breast, and central nervous system.

Indications

• Tumors located near critical structures (e.g., spinal cord, optic nerves)
• Head and neck cancers
• Prostate cancer
• Breast cancer
• Central nervous system tumors
• Other solid tumors where precision is essential

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours before the procedure.
• Diagnostic Tests: Imaging tests such as MRI, CT, or PET scans to map the treatment area accurately.
• Medication Adjustments: Inform your healthcare provider of all medications; some may need to be paused.

Procedure Description

1. Patient Positioning: The patient is positioned on a treatment table, usually with the aid of immobilization devices.
2. Imaging and Mapping: Advanced imaging techniques create a 3D map of the tumor.
3. Treatment Planning: A computer-assisted system plans the precise angles and intensity of the radiation beams.
4. Beam Delivery: The linear accelerator (LINAC) delivers the modulated beams to the targeted area.
5. Verification: Continuous imaging ensures accurate delivery throughout the session.

Tools and Technology Used:

• Linear Accelerator (LINAC)
• Multi-leaf Collimator (MLC)
• Advanced Imaging Systems (MRI, CT, PET)

Anesthesia/Sedation: Generally, none required.

Duration

Each treatment session typically lasts between 15 to 60 minutes.

Setting

Usually performed in a hospital or specialized cancer treatment center.

Personnel

• Radiation Oncologist
• Medical Physicist
• Radiation Therapist
• Oncology Nurse

Risks and Complications

Common Risks:

• Skin irritation or changes
• Fatigue

Rare Risks:

• Damage to surrounding organs and tissues
• Secondary cancers from radiation exposure

Benefits

• Highly precise treatment, sparing healthy tissue
• Reduced side effects compared to conventional radiation therapy
• Effective at treating complex and irregularly shaped tumors
• Immediate benefits include tumor size reduction with minimal discomfort

Recovery

• Post-procedure Care: Regular monitoring and follow-up imaging to assess treatment efficacy.
• Recovery Time: Patients can usually resume normal activities almost immediately.
• Restrictions: Minimal; follow doctor’s advice on activities and diet.

Alternatives

• Conventional External Beam Radiation Therapy
• Stereotactic Radiosurgery (SRS)
• Proton Therapy
• Surgery
• Chemotherapy

Pros and Cons:

• IMRT offers superior precision and fewer side effects compared to conventional radiation but may be more time-consuming and expensive.

Patient Experience

• During Procedure: Generally painless, patients must stay still, mild discomfort from positioning aids.
• After Procedure: Possible mild skin irritation, fatigue. Clear instructions for skincare and managing fatigue will be provided. Comfort measures include hydrating well, eating nutritious food, and rest.