The Overuse of Intensity-modulated Radiotherapy and the Role of the Healthcare Payer

摘要

Intensity-modulated radiotherapy (IMRT) is the delivery of radiation to the patient via fields that have non-uniform radiation fluence. IMRT allows concave dose distributions and dose gradients with narrower margins than those possible using conventional methods [1,2]. IMRT is ideal for irradiating complex treatment volumes and avoiding close proximity organs at risk that may be dose limiting [2]. This can provide increased tumour control through allowing safer dose escalation and/or can reduce normal tissue complications through organ at risk sparing. The technique has been driven by sophisticated, computer-based inverse planning programs and computed tomography-based planning capabilities [3]. IMRT began in the Karolinska Institute in Stockholm in 1982 [4]. The first clinical IMRT in the world by any technique was performed at Baylor College of Medicine, Houston, Texas, USA in March 1994 [5].